Individual
DR. DIANE MARIE STACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S., M.S.
Contact information
Practice address
390 N STEPHANIE ST, SUITE 104, HENDERSON, NV 89014-8028
(702) 947-7700
(702) 932-7700
Mailing address
390 N STEPHANIE ST, SUITE 104, HENDERSON, NV 89014-8028
(702) 947-7700
(702) 932-7700
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
3083
NV
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3083
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S350/S622
SPECIALTY LICENSES
NV
Enumeration date
02/27/2007
Last updated
12/16/2014
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