Provider Demographics
NPI:1235356494
Name:VLACHOS, STACEY DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:DANIEL
Last Name:VLACHOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12585 FENHURST WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-4682
Mailing Address - Country:US
Mailing Address - Phone:239-560-7365
Mailing Address - Fax:239-262-1158
Practice Address - Street 1:12585 FENHURST WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-4682
Practice Address - Country:US
Practice Address - Phone:239-560-7365
Practice Address - Fax:239-262-1158
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice