Provider Demographics
NPI:1639519267
Name:MORRISON, STACIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:A
Last Name:MORRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:A
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3125 E GRAND AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5137
Mailing Address - Country:US
Mailing Address - Phone:307-631-9262
Mailing Address - Fax:
Practice Address - Street 1:3125 E GRAND AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5137
Practice Address - Country:US
Practice Address - Phone:307-426-4014
Practice Address - Fax:307-426-4016
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1351Medicaid