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General NPI Number Information
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NPI Number | 1679688923
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Entity Type | Organization
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Legal Business Name | GEORGE C. STACEY, JR. D.M.D. FAMILY DENISTRY P.C.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 938 FORREST AVE
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City | GADSDEN
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State | AL
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Zip | 35901-3623
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Country | US
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Telephone | 256-546-4947
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Fax | 256-546-8846
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Provider Business Mailing Address
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Address Line | 938 FORREST AVE
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City | GADSDEN
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State | AL
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Zip | 35901-3623
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Country | US
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Telephone | 256-546-4947
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Fax | 256-546-8846
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE CARROLL STACEY JR.
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Credential | D.M.D.
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Telephone | 256-546-4947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5034
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License Number State | AL
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