Provider Demographics
NPI:1366686495
Name:BEARD, STACEY L (DDS)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:L
Last Name:BEARD
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:HIGHWAY 51 EAST
Mailing Address - Street 2:RT 6 BOX 840
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960
Mailing Address - Country:US
Mailing Address - Phone:918-696-8805
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 51 EAST
Practice Address - Street 2:RT 6 BOX 840
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960
Practice Address - Country:US
Practice Address - Phone:918-696-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist