Individual
ALEXANDER THADDEUS STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4301 RAINBOW TROUT DR STE 101, COLUMBIA, MO 65203-6575
(573) 446-2687
Mailing address
4301 RAINBOW TROUT DR STE 101, COLUMBIA, MO 65203-6575
(816) 986-0159
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019031832
IL
1223G0001X
General Practice Dentistry
Primary
2021048524
MO
Other
Enumeration date
08/10/2018
Last updated
02/16/2022
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