Healthcare Provider Details

I. General information

NPI: 1295999761
Provider Name (Legal Business Name): STACEY LEMMONS NORRIS D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 MAIN STREET
PINEVILLE NC
28134
US

IV. Provider business mailing address

PO BOX 686
PINEVILLE NC
28134-0686
US

V. Phone/Fax

Practice location:
  • Phone: 704-889-7525
  • Fax: 704-889-7528
Mailing address:
  • Phone: 704-889-7525
  • Fax: 704-889-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8648
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: