Provider Demographics
NPI:1508892928
Name:MCCARDLE, STANLEY RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:RAY
Last Name:MCCARDLE
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:PO BOX 327
Mailing Address - Street 2:812 MITCHELL STREET
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345-0327
Mailing Address - Country:US
Mailing Address - Phone:334-693-2112
Mailing Address - Fax:334-693-0612
Practice Address - Street 1:812 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:HEADLAND
Practice Address - State:AL
Practice Address - Zip Code:36345-2100
Practice Address - Country:US
Practice Address - Phone:334-693-2112
Practice Address - Fax:334-693-0612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice