Corey Mark Stanley, D.D.S.
Individual provider Active NPI Dentist · Travis Afb, CA
NPI 1881696458 · NPPES record last updated May 8, 2019
Key facts
- NPI
- 1881696458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE7342 (WA)
- Practice address
- 60 MDG/Sgic
101 Bodin Cir
Travis Afb, CA 94535 - Phone
- (707) 423-7008
- NPI assigned
- Aug 12, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE7342 | WA | MD | Dentist |
| D-4796-PE | ID | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D-4796-PE | ID | |
| Dentist | 122300000X | DE7342 | WA | Yes |
Addresses
Primary practice location
60 MDG/Sgic
101 Bodin Cir
Travis Afb, CA 94535
Mailing address
101 Bodin Cir
Travis Afb, CA 94535-1809
Phone (707) 423-7008
Other providers in Travis Afb, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.