Provider Demographics
NPI:1306849112
Name:STACY, LYNN ANN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:STACY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1804
Mailing Address - Country:US
Mailing Address - Phone:315-376-8614
Mailing Address - Fax:315-376-8628
Practice Address - Street 1:7504 E STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1804
Practice Address - Country:US
Practice Address - Phone:315-376-8614
Practice Address - Fax:315-376-8628
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0441371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice