Black, Stacy Lee

Black, Stacy Lee is an individual health care provider with primary practice located at 132 Hatchett St. , Rusk TX 75785. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Black, Stacy Lee can be contacted via phone (903) 683-5751.

Contact Information

Primary practice address
132 Hatchett St. Rusk TX 75785
Phone: (903) 683-5751
Fax: (903) 683-3455
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 17132 Texas

Profile Details

NPI number 1063423085
LBN Legal business name Black, Stacy Lee
Credentials DDS PA
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2006
Last updated Apr 9th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063423085 NPPES
Texas MEDICAID 009120901
Texas Other 36871

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