Provider Demographics
NPI:1326196932
Name:FELIX, STACY K (DMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:K
Last Name:FELIX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:KIRNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1235 W. VISTA WAY
Mailing Address - Street 2:STE H
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-941-1912
Mailing Address - Fax:
Practice Address - Street 1:1235 W VISTA WAY
Practice Address - Street 2:STE H
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6234
Practice Address - Country:US
Practice Address - Phone:760-941-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52742OtherLICENSE