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General NPI Number Information
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NPI Number | 1497891600
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Entity Type | Individual
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Provider Name | STACIE J. TEST D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 BOLIVAR STREET #302 BOX 183
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City | SANGER
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State | TX
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Zip | 76266
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Country | US
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Telephone | 940-458-4747
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Fax | 940-458-4077
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Provider Business Mailing Address
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Address Line | 4904 BOSQUE CT
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3126
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Country | US
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Telephone | 940-458-4747
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Fax | 940-458-4077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16227
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License Number State | TX
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