Provider Demographics
NPI:1215094719
Name:STINGLEY-SEALS, GLORIA JEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:JEAN
Last Name:STINGLEY-SEALS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 JIMMY CARTER BLVD. STE. 320
Mailing Address - Street 2:CARTER-ROCKBRIDGE GENERAL DENTISTRY
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-662-5955
Mailing Address - Fax:770-662-5628
Practice Address - Street 1:5050 JIMMY CARTER BLVD. STE. 320
Practice Address - Street 2:CARTER-ROCKBRIDGE GENERAL DENTISTRY
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-662-5955
Practice Address - Fax:770-662-5628
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582307246OtherTAX ID
GA000678829BMedicaid
GA9181858OtherDORAL
GA100819OtherAVESIS