Provider Demographics
NPI:1861865644
Name:STANLEY HOMETOWN DENTISTRY
Entity Type:Organization
Organization Name:STANLEY HOMETOWN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-644-3601
Mailing Address - Street 1:120 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-1002
Mailing Address - Country:US
Mailing Address - Phone:715-644-3601
Mailing Address - Fax:715-644-3687
Practice Address - Street 1:120 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:WI
Practice Address - Zip Code:54768-1002
Practice Address - Country:US
Practice Address - Phone:715-644-3601
Practice Address - Fax:715-644-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6399015261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental