Provider Demographics
NPI:1386875003
Name:STAFFORD DENTAL ASSOCIATES
Entity type:Organization
Organization Name:STAFFORD DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-369-2273
Mailing Address - Street 1:20 PLANTATION DR STE 139
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-6493
Mailing Address - Country:US
Mailing Address - Phone:540-368-2273
Mailing Address - Fax:540-710-7403
Practice Address - Street 1:20 PLANTATION DR STE 139
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-6493
Practice Address - Country:US
Practice Address - Phone:540-368-2273
Practice Address - Fax:540-710-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008767261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental