Provider Demographics
NPI:1558434555
Name:STANLEY, JOHN DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:STANLEY
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 1:9407 WINFIELD PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-5177
Mailing Address - Country:US
Mailing Address - Phone:334-277-6690
Mailing Address - Fax:334-277-6721
Practice Address - Street 1:2600 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4375
Practice Address - Country:US
Practice Address - Phone:334-277-6690
Practice Address - Fax:334-277-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1658192OtherUNITED CONCORDIA
AL515-25517OtherBLUE CROSS BLUE SHIELD
AL1653750OtherUNITED CONCORDIA
AL515-25362OtherBLUE CROSS BLUE SHIELD