Provider Demographics
NPI:1366584096
Name:FABIO, STANFORD L (DDS)
Entity type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:L
Last Name:FABIO
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:#10 J EST. ST. JOHN
Mailing Address - Street 2:P.O. BOX 1786
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-1786
Mailing Address - Country:US
Mailing Address - Phone:340-778-8155
Mailing Address - Fax:340-778-7082
Practice Address - Street 1:# 10 J EST. ST. JOHN
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00821-1786
Practice Address - Country:US
Practice Address - Phone:340-778-8155
Practice Address - Fax:340-778-7082
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI4551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice