Provider Demographics
NPI:1063194306
Name:STANTON PARK DENTAL PLLC
Entity type:Organization
Organization Name:STANTON PARK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:484-844-2219
Mailing Address - Street 1:5915 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1666
Mailing Address - Country:US
Mailing Address - Phone:484-844-1899
Mailing Address - Fax:
Practice Address - Street 1:500 8TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5236
Practice Address - Country:US
Practice Address - Phone:484-844-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental