Individual
DR. COREY MARK STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
60 MDG/SGIC, 101 BODIN CIR, TRAVIS AFB, CA 94535
(707) 423-7008
Mailing address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-7008
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE7342
WA
1223P0300X
Periodontics
D-4796-PE
ID
Other
Enumeration date
08/12/2005
Last updated
05/08/2019
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