Basic Information
| Provider Information | |||||||||
| NPI: | 1174590319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STINGLEY | ||||||||
| FirstName: | AILEAN | ||||||||
| MiddleName: | CHASE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5043 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392965043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019572343 | ||||||||
| FaxNumber: | 6019572344 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 W GOVERNMENT ST | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018257280 | ||||||||
| FaxNumber: | 6018258130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 07/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | MS260691 | MS | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 00660135 | 05 | MS | MEDICAID |