Provider Demographics
NPI:1881032639
Name:ARBOR, STACIE ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:ALEXANDER
Last Name:ARBOR
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 1:1451 UNION AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6750
Mailing Address - Country:US
Mailing Address - Phone:901-272-1065
Mailing Address - Fax:901-272-7848
Practice Address - Street 1:1451 UNION AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6750
Practice Address - Country:US
Practice Address - Phone:901-272-1065
Practice Address - Fax:901-272-7848
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS005166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist