Provider Demographics
NPI:1417548827
Name:GAY, STANLEY CHRIS (DMD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:CHRIS
Last Name:GAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3281
Mailing Address - Country:US
Mailing Address - Phone:478-274-0286
Mailing Address - Fax:
Practice Address - Street 1:BALDWIN STATE PRISON
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:GA
Practice Address - Zip Code:31034
Practice Address - Country:US
Practice Address - Phone:478-445-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0105451223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health