Keith Wayne Stanley, DDS

Individual provider Active NPI General Practice Dentistry · Wilton, IA

NPI 1649355496 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1649355496
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
IA6220 (IA)
Practice address
325 Cedar St.
Wilton, IA 52778-0007
Phone
(563) 732-2612
Fax
(563) 732-2066
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
IA6220IAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IA6220 IA Yes

Addresses

Primary practice location

325 Cedar St.
Wilton, IA 52778-0007

Mailing address

325 Cedar St.
Wilton, IA 52778-0007
Phone (563) 732-2612

Other providers in Wilton, IA

All providers in Wilton, IA · General Practice Dentistry in Iowa

Sources for this page

Verify at the official NPI Registry.