Provider Demographics
NPI:1821174731
Name:STACHER, KIM ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ALAN
Last Name:STACHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WEST BEAU STREET
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-228-9810
Mailing Address - Fax:724-228-1478
Practice Address - Street 1:150 WEST BEAU STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-228-9810
Practice Address - Fax:724-228-1478
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018632L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist