Individual
DR. MYRA M STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
300 NORTH AIRPORT ROAD, JASPER, AL 35504-3850
(205) 221-6700
(205) 221-9194
Mailing address
300 NORTH AIRPORT ROAD, JASPER, AL 35504-3850
(205) 221-6700
(205) 221-9194
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3788
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139050
UNITED CONCORDIA PROVIDER
AL
01
—
51552873
BLUE CROSS BLUE SHIELD
AL
Enumeration date
07/22/2006
Last updated
07/09/2007
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