Provider Demographics
NPI:1225697394
Name:FECHNER, STACIE JEANNELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:JEANNELLE
Last Name:FECHNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 W 65TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4105
Mailing Address - Country:US
Mailing Address - Phone:314-651-0148
Mailing Address - Fax:
Practice Address - Street 1:13316 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2804
Practice Address - Country:US
Practice Address - Phone:913-851-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist