Provider Demographics
NPI:1548415557
Name:MICHAEL, STACEY CHRISTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:CHRISTINE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2054
Mailing Address - Country:US
Mailing Address - Phone:860-669-5777
Mailing Address - Fax:
Practice Address - Street 1:37 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2054
Practice Address - Country:US
Practice Address - Phone:860-669-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist