Individual
DR. STACY L BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1100 VILLAGE HARBOR DR, LAKE WYLIE FAMILY DENTISTRY PA, LAKE WYLIE, SC 29710
(803) 831-8856
(803) 831-8966
Mailing address
1100 VILLAGE HARBOR DR, LAKE WYLIE, SC 29710
(803) 831-8856
(803) 831-8966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3673
SC
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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