Provider Demographics
NPI:1295957082
Name:DITTMAN, STANLEY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ALAN
Last Name:DITTMAN
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 1:980 TRANCAS ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2933
Mailing Address - Country:US
Mailing Address - Phone:707-226-2310
Mailing Address - Fax:707-226-2673
Practice Address - Street 1:980 TRANCAS ST
Practice Address - Street 2:SUITE 7
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2933
Practice Address - Country:US
Practice Address - Phone:707-226-2310
Practice Address - Fax:707-226-2673
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist