Provider Demographics
NPI:1912087503
Name:FORE, STACY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:M
Last Name:FORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9532
Mailing Address - Country:US
Mailing Address - Phone:530-273-1470
Mailing Address - Fax:530-272-5409
Practice Address - Street 1:984 PLAZA DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9532
Practice Address - Country:US
Practice Address - Phone:530-273-1470
Practice Address - Fax:530-272-5409
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice