Organization
LAKE WYLIE FAMILY DENTISTRY PA
Active
Other names
Dr Thomas N Stall DMD or Dr Stacy L Blackmon DDS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN M STALL (INSURANCE DEPT)
(803) 831-8856
Entity
Organization
Contact information
Practice address
1100 VILLAGE HARBOR DR, LAKE WYLIE, SC 29710
(803) 831-8856
(803) 831-8966
Mailing address
PO BOX 5248, LAKE WYLIE, SC 29710
(803) 831-8856
(803) 831-8966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2830
SC
122300000X
Dentist
3673
SC
Other
Enumeration date
05/02/2007
Last updated
02/04/2008
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