Provider Demographics
NPI:1467533042
Name:GAFFOS, STACI N (DMD)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:N
Last Name:GAFFOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6416
Mailing Address - Country:US
Mailing Address - Phone:803-788-0360
Mailing Address - Fax:803-788-4081
Practice Address - Street 1:9360 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6416
Practice Address - Country:US
Practice Address - Phone:803-788-0360
Practice Address - Fax:803-788-4081
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist