Provider Demographics
NPI:1205151800
Name:STACY. JR., JOSEPH MATTHEW JR (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:STACY. JR.
Suffix:JR
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224
Mailing Address - Country:US
Mailing Address - Phone:412-683-4800
Mailing Address - Fax:412-683-4801
Practice Address - Street 1:4607 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-683-4800
Practice Address - Fax:412-683-4801
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022076-L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics