Blackmon, Stacy L

Blackmon, Stacy L is an individual health care provider with primary practice located at 1100 Village Harbor Dr Lake Wylie Family Dentistry Pa, Lake Wylie SC 29710. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Blackmon, Stacy L can be contacted via phone (803) 831-8856.

Contact Information

Primary practice address
1100 Village Harbor Dr Lake Wylie Family Dentistry Pa Lake Wylie SC 29710
Phone: (803) 831-8856
Fax: (803) 831-8966
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 3673 South Carolina

Profile Details

NPI number 1043334766
LBN Legal business name Blackmon, Stacy L
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 19th, 2007
Last updated Jul 8th, 2007 - about 19 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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