Provider Demographics
NPI:1740308055
Name:WINFORD, STACEY DEPERRO (DMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:DEPERRO
Last Name:WINFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:STASIA
Other - Middle Name:DEPERRO
Other - Last Name:WINFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:410 NORTH JERRY CLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194
Mailing Address - Country:US
Mailing Address - Phone:662-746-3491
Mailing Address - Fax:662-746-3946
Practice Address - Street 1:410 NORTH JERRY CLOWER BLVD
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194
Practice Address - Country:US
Practice Address - Phone:662-746-3491
Practice Address - Fax:662-746-3946
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS284694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist