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General NPI Number Information
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NPI Number | 1760948103
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Entity Type | Organization
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Legal Business Name | THOMAS STACK & ASSOCIATES, DDS, LLC
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 20 E TIMONIUM RD STE 300
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City | TIMONIUM
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State | MD
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Zip | 21093-3458
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Country | US
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Telephone | 301-318-0652
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Fax |
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Provider Business Mailing Address
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Address Line | 217 CABERNET ST
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1280
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Country | US
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Telephone | 301-318-0652
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS JOSEPH STACK
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Credential | DDS
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Telephone | 301-318-0652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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