Provider Demographics
NPI:1811016181
Name:STAFFORD, MARION W (DMD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:W
Last Name:STAFFORD
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 1:1938 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1267
Mailing Address - Country:US
Mailing Address - Phone:404-351-9307
Mailing Address - Fax:404-355-2555
Practice Address - Street 1:1938 PEACHTREE RD NW
Practice Address - Street 2:SUITE 307
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1267
Practice Address - Country:US
Practice Address - Phone:404-351-9307
Practice Address - Fax:404-355-2555
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice