Provider Demographics
NPI:1295757599
Name:STANOVICH, JAMES FLOYD (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FLOYD
Last Name:STANOVICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 PASS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4333
Mailing Address - Country:US
Mailing Address - Phone:228-374-3223
Mailing Address - Fax:228-374-3223
Practice Address - Street 1:1698 PASS RD
Practice Address - Street 2:SUITE E
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4333
Practice Address - Country:US
Practice Address - Phone:228-374-3223
Practice Address - Fax:228-374-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS 1948-811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSMS 1948-81OtherDENTAL LICENSE