Provider Demographics
NPI:1558587477
Name:AULT, STANLEY A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:AULT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:217 N C M ALLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5731
Mailing Address - Country:US
Mailing Address - Phone:512-396-5151
Mailing Address - Fax:512-396-5154
Practice Address - Street 1:217 N C M ALLEN PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5731
Practice Address - Country:US
Practice Address - Phone:512-396-5151
Practice Address - Fax:512-396-5154
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics