Provider Demographics
NPI:1952313132
Name:STANFORD, JOHN DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:STANFORD
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 1:306 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663
Mailing Address - Country:US
Mailing Address - Phone:662-837-7822
Mailing Address - Fax:662-837-1076
Practice Address - Street 1:306 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663
Practice Address - Country:US
Practice Address - Phone:662-837-7822
Practice Address - Fax:662-837-1076
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS250889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0060036Medicaid