Provider Demographics
NPI:1255422317
Name:HALPERN, STANLEY DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:DAVID
Last Name:HALPERN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MR
Other - First Name:STANLEY
Other - Middle Name:DAVID
Other - Last Name:HALPERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4001 CANTON RD
Mailing Address - Street 2:STE 1
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2739
Mailing Address - Country:US
Mailing Address - Phone:770-928-6655
Mailing Address - Fax:770-928-6656
Practice Address - Street 1:4001 CANTON RD
Practice Address - Street 2:STE 1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2739
Practice Address - Country:US
Practice Address - Phone:770-928-6655
Practice Address - Fax:770-928-6656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics