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NPI Code Detail

MEDICARE: ROBERT L STACEY D.D.S.

MEDICARE:   ROBERT L STACEY  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistCO6828CO

General Provider Information

NPI Number : 1306846506
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT L STACEY D.D.S.
Provider Business Mailing Address
First Line : 1930 BLUE MESA CT
Second Line :
City : LOVELAND
State : CO
Zip : 80538-4125
Country : US
Telephone Number : 970-667-2040
Fax Number : 970-667-2042
Provider Business Practice Location Address
First Line : 1930 BLUE MESA CT
Second Line :
City : LOVELAND
State : CO
Zip : 80538-4125
Country : US
Telephone Number : 970-667-2040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 07/08/2007

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Directions to “ ROBERT L STACEY D.D.S.” Practice Location

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