Provider Demographics
NPI:1649726688
Name:STANLEY, PAUL RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
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 1:9781 SIERRA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-1716
Mailing Address - Country:US
Mailing Address - Phone:909-823-4400
Mailing Address - Fax:909-429-2230
Practice Address - Street 1:9781 SIERRA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1716
Practice Address - Country:US
Practice Address - Phone:909-823-4400
Practice Address - Fax:909-429-2230
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist