Provider Demographics
NPI:1568973089
Name:TODD T. STANSBERRY, D.D.S. , PLLC
Entity Type:Organization
Organization Name:TODD T. STANSBERRY, D.D.S. , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-867-8882
Mailing Address - Street 1:5501 INDEPENDENCE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5445
Mailing Address - Country:US
Mailing Address - Phone:972-867-8882
Mailing Address - Fax:972-867-9321
Practice Address - Street 1:5501 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5445
Practice Address - Country:US
Practice Address - Phone:972-867-8882
Practice Address - Fax:972-867-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24177261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental