Provider Demographics
NPI:1154546117
Name:STANLEY, JOEL CHADWICK (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:CHADWICK
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S 28TH AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2524
Mailing Address - Country:US
Mailing Address - Phone:601-579-6399
Mailing Address - Fax:601-579-9990
Practice Address - Street 1:704 S 28TH AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2524
Practice Address - Country:US
Practice Address - Phone:601-579-6399
Practice Address - Fax:601-579-9990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3070-981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics