Provider Demographics
NPI:1013340215
Name:STANLEY, SPENCER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:D
Last Name:STANLEY
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 1:148 46TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4643
Mailing Address - Country:US
Mailing Address - Phone:318-791-0340
Mailing Address - Fax:
Practice Address - Street 1:1424 SADDLE CRST
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5644
Practice Address - Country:US
Practice Address - Phone:318-791-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist