Provider Demographics
NPI:1720820160
Name:ROBINSON, STACEY DENISE (DMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:DENISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-2195
Mailing Address - Country:US
Mailing Address - Phone:239-322-7499
Mailing Address - Fax:
Practice Address - Street 1:1451 E UNION AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1770
Practice Address - Country:US
Practice Address - Phone:217-324-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist