Provider Demographics
NPI:1437512480
Name:STANLEY, TONY MICHAEL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:MICHAEL
Last Name:STANLEY
Suffix:JR
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 1:5750 STEVEHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-5998
Mailing Address - Country:US
Mailing Address - Phone:706-502-0722
Mailing Address - Fax:
Practice Address - Street 1:137 PROMINENCE CT STE 140
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8938
Practice Address - Country:US
Practice Address - Phone:706-265-6877
Practice Address - Fax:866-923-3790
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA0154901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program