Provider Demographics
NPI:1043479546
Name:VERKLER, STACEY KNELLINGER
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:KNELLINGER
Last Name:VERKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:KNELLINGER-VERKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1246 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4316
Mailing Address - Country:US
Mailing Address - Phone:727-785-3383
Mailing Address - Fax:727-785-3378
Practice Address - Street 1:1246 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4316
Practice Address - Country:US
Practice Address - Phone:727-785-3383
Practice Address - Fax:727-785-3378
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist