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General NPI Number Information
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NPI Number | 1891756094
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Entity Type | Individual
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Provider Name | STACEY MARIE GOLDEN DDS
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Gender | Female
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 12420 130TH AVE
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City | LARGO
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State | FL
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Zip | 33774-1950
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Country | US
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Telephone | 727-588-4040
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Fax | 727-588-4726
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Provider Business Mailing Address
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Address Line | 8341 144TH LN
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City | SEMINOLE
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State | FL
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Zip | 33776-2803
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Country | US
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Telephone | 727-588-4040
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Fax | 727-588-4726
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 15021
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License Number State | FL
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