Individual
DR. MICHAEL JOHN STACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
921 SHIRLEY RD, BUNKIE, LA 71322-1542
(318) 346-6668
(318) 346-6142
Mailing address
921 SHIRLEY RD, BUNKIE, LA 71322-1542
(318) 346-6668
(318) 346-6142
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3790
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1837903
—
LA
Enumeration date
06/10/2005
Last updated
11/22/2011
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