Provider Demographics
NPI:1922477462
Name:DR. ROBERT J. STANCILL, DDS, MS, PLLC
Entity Type:Organization
Organization Name:DR. ROBERT J. STANCILL, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANCILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:919-239-4940
Mailing Address - Street 1:4601 LAKE BOONE TRL STE 2A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7503
Mailing Address - Country:US
Mailing Address - Phone:919-239-4940
Mailing Address - Fax:919-322-0503
Practice Address - Street 1:4601 LAKE BOONE TRL STE 2A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-239-4940
Practice Address - Fax:919-322-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty