Individual
DR. MARTIN HARROD STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
334 BLOOMFIELD STREET, SUITE 102, JOHNSTOWN, PA 15904
(814) 266-2312
Mailing address
300 CHERRY LANE, JOHNSTOWN, PA 15904
(814) 266-2316
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS020910L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006325800003
ACCESS MA PROVIDER ID
PA
01
—
138959
UNITED CONCORDIA
—
Enumeration date
10/05/2006
Last updated
07/08/2007
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