Provider Demographics
NPI:1629004585
Name:STANBERY, JOHN S (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:STANBERY
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 1:413 BERYWOOD TRL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5285
Mailing Address - Country:US
Mailing Address - Phone:423-472-0067
Mailing Address - Fax:423-476-2021
Practice Address - Street 1:413 BERYWOOD TRL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5285
Practice Address - Country:US
Practice Address - Phone:423-472-0067
Practice Address - Fax:423-476-2021
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS50531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice