Healthcare Provider Details

I. General information

NPI: 1962313171
Provider Name (Legal Business Name): STACKHOUSE FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 BROOKFIELD RD
COLUMBIA SC
29223-2207
US

IV. Provider business mailing address

207 BELFAST WAY
LEXINGTON SC
29073-9807
US

V. Phone/Fax

Practice location:
  • Phone: 864-399-8137
  • Fax:
Mailing address:
  • Phone: 864-399-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANESA CHANERA STACKHOUSE
Title or Position: GENERAL DENTIST/OWNER
Credential: DMD
Phone: 864-399-8137