Provider Demographics
NPI:1073699963
Name:WOO, STACEY M (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:WOO
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 E. SANTA ANA CANYON RD.
Mailing Address - Street 2:#G395
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:530-428-5443
Mailing Address - Fax:
Practice Address - Street 1:5753 E. SANTA ANA CANYON RD.
Practice Address - Street 2:#G395
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:530-428-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics