Provider Demographics
NPI:1770922379
Name:STANLEY, NATHAN BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:BRIAN
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ZIMMERMAN TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7652
Mailing Address - Country:US
Mailing Address - Phone:406-248-3303
Mailing Address - Fax:913-333-5084
Practice Address - Street 1:1601 ZIMMERMAN TRL STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7652
Practice Address - Country:US
Practice Address - Phone:406-248-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-154961223P0221X
KS61026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry