Provider Demographics
NPI:1306138466
Name:DENT, STACEY (DC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:DENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23620 THREE NOTCH RD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-3083
Mailing Address - Country:US
Mailing Address - Phone:240-237-8281
Mailing Address - Fax:
Practice Address - Street 1:23620 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-3082
Practice Address - Country:US
Practice Address - Phone:240-237-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor