Provider Demographics
NPI:1417027939
Name:STANSELL & PETREE FAMILY DENTISTRY, P. C.
Entity Type:Organization
Organization Name:STANSELL & PETREE FAMILY DENTISTRY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:STANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-867-2277
Mailing Address - Street 1:369 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2278
Mailing Address - Country:US
Mailing Address - Phone:770-867-2277
Mailing Address - Fax:770-868-5988
Practice Address - Street 1:369 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2278
Practice Address - Country:US
Practice Address - Phone:770-867-2277
Practice Address - Fax:770-868-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98361223G0001X
GA107051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty