Provider Demographics
NPI:1467637561
Name:STEIN, STACY ALICIA (DMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ALICIA
Last Name:STEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ALICIA
Other - Last Name:GOLDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:14560 S MILITARY TRL STE B2
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-394-9000
Practice Address - Fax:561-988-1102
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice