Provider Demographics
NPI:1427102664
Name:MANLOVE, STACY LYNN
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:MANLOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2507
Mailing Address - Country:US
Mailing Address - Phone:361-888-8603
Mailing Address - Fax:361-888-8610
Practice Address - Street 1:3205 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2507
Practice Address - Country:US
Practice Address - Phone:361-888-8603
Practice Address - Fax:361-888-8610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist