| NPI | 1275200933 |
|---|---|
| Professional Name | JUSTIN DAVID STACY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 13386) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859181) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2023-07-31 |