Provider Demographics
NPI:1952718553
Name:DAVID P. STANGL, JR., DMD, PROFESSIONAL LLC
Entity Type:Organization
Organization Name:DAVID P. STANGL, JR., DMD, PROFESSIONAL LLC
Other - Org Name:FOLSOM FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:STANGL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:303-945-2399
Mailing Address - Street 1:2880 FOLSOM ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3769
Mailing Address - Country:US
Mailing Address - Phone:303-945-2399
Mailing Address - Fax:303-945-2571
Practice Address - Street 1:2880 FOLSOM ST STE 202
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3769
Practice Address - Country:US
Practice Address - Phone:303-945-2399
Practice Address - Fax:303-945-2571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID P. STANGL, JR., DMD, PROFESSIONAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO99841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty