Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901018750 | MI |
Y | 1223P0700X | Prosthodontist | 2901018750 | MI |
NPI | 1003038431 |
---|---|
Provider Name | Dr. Angela Kay Stanton |
First Address | Davis-Monthan Afb, AZ 85707-4405 |
Second Address | Davis-Monthan Afb, AZ 85707-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/02/2022 |