Provider Demographics
NPI:1821629312
Name:STANLEY DENTAL LLC
Entity Type:Organization
Organization Name:STANLEY DENTAL LLC
Other - Org Name:ISLAND SMILES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DENTAL LLC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-877-7661
Mailing Address - Street 1:74 LONO AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1626
Mailing Address - Country:US
Mailing Address - Phone:808-877-7661
Mailing Address - Fax:
Practice Address - Street 1:74 LONO AVE STE 210
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1626
Practice Address - Country:US
Practice Address - Phone:808-877-7661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty