Provider Demographics
NPI:1982639605
Name:QUO, STACEY D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:D
Last Name:QUO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2904
Mailing Address - Country:US
Mailing Address - Phone:650-328-1600
Mailing Address - Fax:650-327-6556
Practice Address - Street 1:738 MIDDLEFIELD ROAD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-328-1600
Practice Address - Fax:650-327-6556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics