Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3070-98 | MS |
NPI | 1154546117 |
---|---|
Provider Name | Dr. Joel Chadwick Stanley |
First Address | Hattiesburg, MS 39402-2524 |
Second Address | Hattiesburg, MS 39402-2524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |