Provider Demographics
NPI:1134221633
Name:STANLEY, DAVID LEE (DMD, PLLC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DMD, PLLC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:LEE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD,PLLC
Mailing Address - Street 1:34 MAPLEVILLE DEPOT
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1857
Mailing Address - Country:US
Mailing Address - Phone:802-524-4844
Mailing Address - Fax:802-524-5646
Practice Address - Street 1:34 MAPLEVILLE DEPOT
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1857
Practice Address - Country:US
Practice Address - Phone:802-524-4844
Practice Address - Fax:802-524-5646
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT11911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004105Medicaid