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Organization
STACY BLACK, DDS, PA
Active
Organization
STACY BLACK, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACY LEE BLACK DDS (MEMBER/PRESIDENT)
(903) 683-5751
Entity
Organization
Contact information
Practice address
132 HATCHETT, RUSK, TX 75785
(903) 683-5751
Mailing address
PO BOX 316, RUSK, TX 75785-0316
(903) 683-5751
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17132
TX
Other
Enumeration date
03/31/2015
Last updated
03/31/2015
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