Provider Demographics
NPI:1275545956
Name:HOWLETT, STACEY M
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:HOWLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ELM ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3300
Mailing Address - Country:US
Mailing Address - Phone:315-265-5344
Mailing Address - Fax:
Practice Address - Street 1:150 ELM ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3300
Practice Address - Country:US
Practice Address - Phone:315-265-5344
Practice Address - Fax:315-261-4799
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist