Stacy Lee Black, DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17132 Issued in TX

Practice address

132 Hatchett St.
Rusk, TX 75785

Phone

(903) 683-5751

Fax

(903) 683-3455

NPI assigned

Aug 11, 2006

Last updated

May 28, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stacy Black, DDS, PA

  • General Practice Dentistry
  • Rusk, TX
  • NPI 1831584598
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1063423085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 316",
            "city": "RUSK",
            "state": "TX",
            "postal_code": "757850316",
            "telephone_number": "903-683-5751",
            "fax_number": "903-683-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 HATCHETT ST.",
            "city": "RUSK",
            "state": "TX",
            "postal_code": "75785",
            "telephone_number": "903-683-5751",
            "fax_number": "903-683-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "STACY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "DDS PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "17132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENT",
            "identifier": "36871",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009120901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Simone Atkins, COTA
• Baylor County Hospital District (Avir at Rusk)
• Stacey Rose Belcher, M.D.
• Birmingham Health Care Center, L.P. (Birmingham Health Care Center)
• Birmingham SNF LLC (Birmingham Health Care Center)
• Bonner Emergency Medicine Associates PA
• Brookshire Brothers Inc (Brookshire Brothers Pharmacy)
• Shana L Brown, CNP
• Troy Caldwell, MD
• Centers for Long Term Care of Texas, Inc

• General Practice Dentistry in Rusk, TX
• Providers in Rusk, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.