Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 09071 | IA |
NPI | 1023336104 |
---|---|
Provider Name | Dr. Adam C Stanley |
First Address | Omaha, NE 68164-5431 |
Second Address | South Jordan, UT 84009-7163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 12/03/2020 |