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Individual
MR. STACY LEE BLACK
Active
Individual
MR. STACY LEE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS PA
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17132
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009120901
—
TX
01
—
36871
DENT
TX
Enumeration date
08/11/2006
Last updated
05/28/2025
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