Provider Demographics
NPI:1265488498
Name:BAALBAKY, STACIE ANN (DDS)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN
Last Name:BAALBAKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:ANN
Other - Last Name:LIBERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7835 S RAINBOW BLVD
Mailing Address - Street 2:#28
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139
Mailing Address - Country:US
Mailing Address - Phone:702-898-8448
Mailing Address - Fax:702-369-8001
Practice Address - Street 1:7835 S RAINBOW BLVD
Practice Address - Street 2:#28
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139
Practice Address - Country:US
Practice Address - Phone:702-898-8448
Practice Address - Fax:702-369-8001
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice