Provider Demographics
NPI:1922197524
Name:HIRST, STANLEY BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:BRIAN
Last Name:HIRST
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 1:1839 S.. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3837
Mailing Address - Country:US
Mailing Address - Phone:701-839-1299
Mailing Address - Fax:
Practice Address - Street 1:1839 S. BROADWAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3837
Practice Address - Country:US
Practice Address - Phone:701-839-1299
Practice Address - Fax:701-839-0015
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND80878Medicaid