Provider Demographics
NPI:1316161011
Name:STANTON, ANNELI VIRPI (DENTIST)
Entity type:Individual
Prefix:DR
First Name:ANNELI
Middle Name:VIRPI
Last Name:STANTON
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RADNOR AVE
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2612
Mailing Address - Country:US
Mailing Address - Phone:914-271-8727
Mailing Address - Fax:
Practice Address - Street 1:329 ROUTE 202
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3103
Practice Address - Country:US
Practice Address - Phone:845-354-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0366611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00770347Medicaid