Provider Demographics
NPI:1669616116
Name:STANSBURY, C. MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:C.
Middle Name:MICHAEL
Last Name:STANSBURY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7733
Mailing Address - Country:US
Mailing Address - Phone:606-329-9700
Mailing Address - Fax:606-329-9701
Practice Address - Street 1:2179 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7733
Practice Address - Country:US
Practice Address - Phone:606-329-9700
Practice Address - Fax:606-329-9701
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics