Provider Demographics
NPI:1932123395
Name:SAUNDERS, STANLEY BENJAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:BENJAMIN
Last Name:SAUNDERS
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 1:4711 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7839
Mailing Address - Country:US
Mailing Address - Phone:850-526-7748
Mailing Address - Fax:850-526-3388
Practice Address - Street 1:4711 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7839
Practice Address - Country:US
Practice Address - Phone:850-526-7748
Practice Address - Fax:850-526-3388
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071772000Medicaid
FL688415696Medicaid