Provider Demographics
NPI:1508823840
Name:STANCOVEN, BRIAN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:STANCOVEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE ROAD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY HAWAII
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859
Mailing Address - Country:US
Mailing Address - Phone:808-433-1021
Mailing Address - Fax:808-433-3928
Practice Address - Street 1:1 JARRETT WHITE ROAD, BLDG 320 KRUKOWSKI STREET
Practice Address - Street 2:USA DENTAC
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-1021
Practice Address - Fax:808-433-3928
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218331223G0001X
TX00218331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice