Stacey, Diane Marie

Stacey, Diane Marie is an sole proprietor health care provider with primary practice located at 390 N Stephanie St Suite 104, Henderson NV 89014-8028. She recently has 2 registered licenses in different health care specialties including Dental Providers / Pediatric Dentistry, Dental Providers / Orthodontics and Dentofacial Orthopedics. Dental Providers / Orthodontics and Dentofacial Orthopedics is her primary health care specialty. Stacey, Diane Marie can be contacted via phone (702) 947-7700.

Contact Information

Primary practice address
390 N Stephanie St Suite 104 Henderson NV 89014-8028
Phone: (702) 947-7700
Fax: (702) 932-7700
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 3083 Nevada
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 3083 Nevada

Profile Details

NPI number 1073640991
LBN Legal business name Stacey, Diane Marie
Credentials D.D.S., M.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 27th, 2007
Last updated Dec 16th, 2014 - about 11 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 1073640991 NPPES
Nevada Other S350/S622 SPECIALTY LICENSES

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