Provider Demographics
NPI:1952312696
Name:STANMAN, RICHARD N (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:STANMAN
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 1:11600 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5781
Mailing Address - Country:US
Mailing Address - Phone:310-473-8770
Mailing Address - Fax:310-477-5818
Practice Address - Street 1:11600 WILSHIRE BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5781
Practice Address - Country:US
Practice Address - Phone:310-473-8770
Practice Address - Fax:310-477-5818
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist