Basic Information
| Provider Information | |||||||||
| NPI: | 1619094323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.D.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1522 E A ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072336000 | ||||||||
| FaxNumber: | 3072356202 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 E A ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072653622 | ||||||||
| FaxNumber: | 3072653027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 786 | WY | Y | Dental Providers | Dental Hygienist |
No ID Information.