Provider Demographics
NPI:1487793543
Name:STALLINGS, EDDIE RAY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:RAY
Last Name:STALLINGS
Suffix:JR
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 1:8428 DORSEY CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8302
Mailing Address - Country:US
Mailing Address - Phone:703-335-5886
Mailing Address - Fax:
Practice Address - Street 1:8428 DORSEY CIR STE 102
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8302
Practice Address - Country:US
Practice Address - Phone:703-335-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist