Provider Demographics
NPI:1194933283
Name:VAN SCOYOC, STACEY KARZEN (DDS)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:KARZEN
Last Name:VAN SCOYOC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HERSHEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3730
Mailing Address - Country:US
Mailing Address - Phone:309-664-0570
Mailing Address - Fax:
Practice Address - Street 1:908 N HERSHEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3730
Practice Address - Country:US
Practice Address - Phone:309-664-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice