Provider Demographics
NPI:1396829743
Name:HACKNEY, STEPHANIE GRAY (DDS , PA)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GRAY
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:DDS , PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 MILITARY CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3633
Mailing Address - Country:US
Mailing Address - Phone:910-256-9292
Mailing Address - Fax:910-256-9792
Practice Address - Street 1:1337 MILITARY CUTOFF RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3633
Practice Address - Country:US
Practice Address - Phone:910-256-9292
Practice Address - Fax:910-256-9792
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC122300000XOtherTAXONOMY