Provider Demographics
NPI:1386733954
Name:SATTERFIELD, STANLEY D (DMD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:D
Last Name:SATTERFIELD
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 1:2000 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6022
Mailing Address - Country:US
Mailing Address - Phone:706-543-8377
Mailing Address - Fax:706-548-2509
Practice Address - Street 1:2000 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6022
Practice Address - Country:US
Practice Address - Phone:706-543-8377
Practice Address - Fax:706-548-2509
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00221691A3Medicaid
GA11482856OtherCAQH
GA279254OtherBLUE SHIELD
GA421490OtherUNITED CONCORDIA
GA00221691A3Medicaid
GAU25493Medicare UPIN