Provider Demographics
NPI:1710074737
Name:STAINBACK, FRANK PLEASANTS III (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:PLEASANTS
Last Name:STAINBACK
Suffix:III
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 1:912 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2118
Mailing Address - Country:US
Mailing Address - Phone:662-453-5143
Mailing Address - Fax:662-453-5143
Practice Address - Street 1:912 MEDALLION DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2118
Practice Address - Country:US
Practice Address - Phone:662-453-5143
Practice Address - Fax:662-453-5143
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1732-761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00064510Medicaid