Provider Demographics
NPI:1295883957
Name:MARABLE, STANLEY BERNARD (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:BERNARD
Last Name:MARABLE
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 1:308 JANET ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2602
Mailing Address - Country:US
Mailing Address - Phone:229-244-5644
Mailing Address - Fax:229-247-1412
Practice Address - Street 1:308 JANET ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2602
Practice Address - Country:US
Practice Address - Phone:229-244-5644
Practice Address - Fax:229-247-1412
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0109101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9184102Medicaid
GA00043153BMedicaid
GA101089Medicaid