Provider Demographics
NPI:1881944544
Name:STANLEY, ALFRED RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:RYAN
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 1:6200 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3534
Mailing Address - Country:US
Mailing Address - Phone:910-350-0441
Mailing Address - Fax:910-350-2776
Practice Address - Street 1:6200 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3534
Practice Address - Country:US
Practice Address - Phone:910-350-0441
Practice Address - Fax:910-350-2776
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC39691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998067Medicaid