Provider Demographics
NPI:1316233893
Name:STANLEY, BO JAMES (DDS)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:JAMES
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 S LAMAR BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7990
Mailing Address - Country:US
Mailing Address - Phone:512-442-7897
Mailing Address - Fax:
Practice Address - Street 1:3901 S LAMAR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7990
Practice Address - Country:US
Practice Address - Phone:512-442-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND129251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice