| Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds | |
|
1100 Village Harbor Dr Lake Wylie SC 29710 | |
| (803) 831-8856 | |
| (803) 831-8966 |
| Full Name | Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds |
|---|---|
| Speciality | Dentist |
| Location | 1100 Village Harbor Dr, Lake Wylie, South Carolina |
| Authorized Official Name and Position | Susan M Stall (INSURANCE DEPT) |
| Authorized Official Contact | 8038318856 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds Po Box 5248 Lake Wylie SC 29710 Ph: (803) 831-8856 | Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds 1100 Village Harbor Dr Lake Wylie SC 29710 Ph: (803) 831-8856 |
| NPI Number | 1437370798 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 02/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437370798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2830 (South Carolina) | Primary |
| 122300000X | Dentist | 3673 (South Carolina) | Secondary |
Lake Wylie Modern Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 Highway 274, Lake Wylie, SC 29710 Phone: 803-752-0565 | |
Carolina Family Dentistry At Lake Wylie Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 244 Latitude Ln Ste 103, Lake Wylie, SC 29710 Phone: 803-831-2171 Fax: 803-831-2172 |