Provider Demographics
NPI:1700260692
Name:STANSBERRY FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:STANSBERRY FAMILY DENTISTRY PLLC
Other - Org Name:NORTHERNSMILES DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-944-9197
Mailing Address - Street 1:7501 N 16TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4677
Mailing Address - Country:US
Mailing Address - Phone:602-944-9197
Mailing Address - Fax:
Practice Address - Street 1:7501 N. 16TH ST. #100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-944-9197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty