Provider Demographics
NPI:1790819753
Name:STANFORD, ROBERT ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:STANFORD
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 1:15750 S HARLEM AVE
Mailing Address - Street 2:SUITE 36
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5279
Mailing Address - Country:US
Mailing Address - Phone:708-429-5575
Mailing Address - Fax:708-429-5817
Practice Address - Street 1:15750 S HARLEM AVE
Practice Address - Street 2:SUITE 36
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5279
Practice Address - Country:US
Practice Address - Phone:708-429-5575
Practice Address - Fax:708-429-5817
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice