Provider Demographics
NPI:1134950256
Name:HANCOCK, STACEY RAE (BSDH, RDH)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:RAE
Last Name:HANCOCK
Suffix:
Gender:
Credentials:BSDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 CEDAR GLADES DR STE C
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3203
Mailing Address - Country:US
Mailing Address - Phone:615-212-2377
Mailing Address - Fax:
Practice Address - Street 1:574 W SAM RIDLEY PKWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5621
Practice Address - Country:US
Practice Address - Phone:615-488-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10516124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist