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 |