Provider Demographics
NPI:1417021890
Name:SCHMITT, STACY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:SCHMITT
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 1:225 WHITEROCK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-8101
Mailing Address - Country:US
Mailing Address - Phone:704-908-4210
Mailing Address - Fax:
Practice Address - Street 1:10616 METROMONT PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269
Practice Address - Country:US
Practice Address - Phone:704-597-2570
Practice Address - Fax:704-597-2572
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901634Medicaid