Provider Demographics
NPI:1295034353
Name:POMALES, STACEY LYNN (CDA, RDA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:POMALES
Suffix:
Gender:F
Credentials:CDA, RDA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:KRISTOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1103 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6915
Mailing Address - Country:US
Mailing Address - Phone:856-692-9333
Mailing Address - Fax:856-692-5565
Practice Address - Street 1:1103 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6915
Practice Address - Country:US
Practice Address - Phone:856-692-9333
Practice Address - Fax:856-692-5565
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant