Provider Demographics
NPI:1649391731
Name:CLAIRE STAGG DDS PA
Entity Type:Organization
Organization Name:CLAIRE STAGG DDS PA
Other - Org Name:MERCURY FREE DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-777-2797
Mailing Address - Street 1:2120 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4924
Mailing Address - Country:US
Mailing Address - Phone:321-777-2797
Mailing Address - Fax:321-777-6887
Practice Address - Street 1:2120 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4924
Practice Address - Country:US
Practice Address - Phone:321-777-2797
Practice Address - Fax:321-777-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00120781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty