Provider Demographics
NPI:1295861862
Name:LAW, STACEY JANELLE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:JANELLE
Last Name:LAW
Suffix:
Gender:F
Credentials:DDS, MS
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Other - Credentials:
Mailing Address - Street 1:877 W FREMONT AVE
Mailing Address - Street 2:SUITE J-2
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2315
Mailing Address - Country:US
Mailing Address - Phone:408-738-8400
Mailing Address - Fax:408-738-8424
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:SUITE J-2
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-738-8400
Practice Address - Fax:408-738-8424
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA383151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics