1780831990 NPI number — DR. TRENT EVERETT STANSBURY D.D.S

Table of content: (NPI 1275863912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780831990 NPI number — DR. TRENT EVERETT STANSBURY D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANSBURY
Provider First Name:
TRENT
Provider Middle Name:
EVERETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780831990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 OLD N KENTUCKY ST
Provider Second Line Business Mailing Address:
KINGSTON DENTAL LLC
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37763-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-717-3586
Provider Business Mailing Address Fax Number:
865-717-3581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N KENTUCKY ST
Provider Second Line Business Practice Location Address:
KINGSTON DENTAL LLC
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37763-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-717-3586
Provider Business Practice Location Address Fax Number:
865-717-3581
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  8988 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1515053 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com