Provider Demographics
NPI:1205823242
Name:STANLEY, GREGORY J (DDS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
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 1:318 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1779
Mailing Address - Country:US
Mailing Address - Phone:508-697-5530
Mailing Address - Fax:508-279-1460
Practice Address - Street 1:318 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1779
Practice Address - Country:US
Practice Address - Phone:508-697-5530
Practice Address - Fax:508-279-1460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice