Provider Demographics
NPI:1073824843
Name:TEMPLE, STACY (DMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:TEMPLE
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 1:1261 FURNACE BROOK PKWY STE 12A
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4762
Mailing Address - Country:US
Mailing Address - Phone:617-472-3700
Mailing Address - Fax:
Practice Address - Street 1:1261 FURNACE BROOK PKWY STE 12A
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4762
Practice Address - Country:US
Practice Address - Phone:617-472-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10955122300000X
MADN1855737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist