Provider Demographics
NPI:1629488770
Name:STACIA M. DOWELL DDS, PLLC
Entity Type:Organization
Organization Name:STACIA M. DOWELL DDS, PLLC
Other - Org Name:AESTHETIC & RESTORATIVE DENTISTRY OF NORMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-360-0215
Mailing Address - Street 1:707 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3987
Mailing Address - Country:US
Mailing Address - Phone:405-360-0215
Mailing Address - Fax:405-366-8663
Practice Address - Street 1:707 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3987
Practice Address - Country:US
Practice Address - Phone:405-360-0215
Practice Address - Fax:405-366-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6468302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization