Provider Demographics
NPI:1013139484
Name:MAHAN, STAN R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:R
Last Name:MAHAN
Suffix:JR
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 1:2494 MOORE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8187
Mailing Address - Country:US
Mailing Address - Phone:732-255-8844
Mailing Address - Fax:732-255-0544
Practice Address - Street 1:2494 MOORE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8187
Practice Address - Country:US
Practice Address - Phone:732-255-8844
Practice Address - Fax:732-255-0544
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist