Provider Demographics
NPI:1942921606
Name:LARKIN, STACEY NICOLE (RDH, OMT)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:NICOLE
Last Name:LARKIN
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 W GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-2207
Mailing Address - Country:US
Mailing Address - Phone:817-235-2737
Mailing Address - Fax:
Practice Address - Street 1:1022 W GARRISON ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2207
Practice Address - Country:US
Practice Address - Phone:817-235-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12158124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist