Provider Demographics
NPI:1932220977
Name:NORMAN, STACY L (DDS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:NORMAN
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 1:2325 TIMBER SHADOWS DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2028
Mailing Address - Country:US
Mailing Address - Phone:281-359-9100
Mailing Address - Fax:281-359-0130
Practice Address - Street 1:2325 TIMBER SHADOWS DR BLDG A
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2028
Practice Address - Country:US
Practice Address - Phone:281-359-9100
Practice Address - Fax:281-359-0130
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice