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General NPI Number Information
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NPI Number | 1801511753
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Entity Type | Organization
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Legal Business Name | STACY POOLE, DMD, INC.
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1505 SHEPARD DR STE 101
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City | SANTA MARIA
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State | CA
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Zip | 93454-7016
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Country | US
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Telephone | 805-922-4778
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Fax | 805-928-9811
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Provider Business Mailing Address
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Address Line | 1505 SHEPARD DR STE 101
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City | SANTA MARIA
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State | CA
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Zip | 93454-7016
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Country | US
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Telephone | 805-922-4778
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Fax | 805-928-9811
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. STACY POOLE
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Credential | DMD
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Telephone | 805-922-4778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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