Provider Demographics
NPI:1194357277
Name:SMITH, STACI MEGAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:MEGAN
Last Name:SMITH
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 1:2592 MERRICK RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5742
Mailing Address - Country:US
Mailing Address - Phone:516-781-9700
Mailing Address - Fax:
Practice Address - Street 1:2592 MERRICK RD UNIT C
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5742
Practice Address - Country:US
Practice Address - Phone:516-781-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0620701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice