Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | NY035947 | NY |
NPI | 1043419864 |
---|---|
Provider Name | Dr. Jeffrey Brian Stannard |
First Address | Syracuse, NY 13210-1808 |
Second Address | Syracuse, NY 13210-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 12/07/2007 |