Provider Demographics
NPI:1396838496
Name:STACIE A ARBOR DDS PLLC
Entity Type:Organization
Organization Name:STACIE A ARBOR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARBOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-272-1065
Mailing Address - Street 1:1451 UNION AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6750
Mailing Address - Country:US
Mailing Address - Phone:901-272-1065
Mailing Address - Fax:901-272-7848
Practice Address - Street 1:1451 UNION AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6750
Practice Address - Country:US
Practice Address - Phone:901-272-1065
Practice Address - Fax:901-272-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS5166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty