Provider Demographics
NPI:1972631596
Name:LIND, STACY DOYLE (DMD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:DOYLE
Last Name:LIND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8290 S HOLLY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-770-9901
Mailing Address - Fax:303-221-5040
Practice Address - Street 1:8290 S HOLLY ST
Practice Address - Street 2:SUITE A
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:303-770-9901
Practice Address - Fax:303-221-5040
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice