Provider Demographics
NPI:1558477414
Name:SUGGS, STACI (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:
Last Name:SUGGS
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 1:1651 SOUTHSIDE CONNECTOR BLVD., #1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-821-3413
Mailing Address - Fax:904-821-3418
Practice Address - Street 1:1651 SOUTHSIDE CONNECTOR BLVD., #1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:904-821-3413
Practice Address - Fax:904-821-3418
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 153441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075805100Medicaid
FL70050OtherADI HEALTHY KIDS
FL075826400Medicaid