Provider Demographics
NPI:1447007513
Name:STANFORD, KIERSTEN FAITH
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:FAITH
Last Name:STANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715A DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2209
Mailing Address - Country:US
Mailing Address - Phone:228-374-4991
Mailing Address - Fax:
Practice Address - Street 1:951 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451
Practice Address - Country:US
Practice Address - Phone:769-303-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4817-22DH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist