Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7599 | NC |
NPI | 1114018413 |
---|---|
Provider Name | Dr. Stacy L Dinges |
First Address | Cornelius, NC 28031-2516 |
Second Address | Albemarle, NC 28001-2819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
902M5 | (05) | NC |