Justin Stacy, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

13386 Issued in NC

Practice address

9660 Falls of Neuse Rd Unit 153
Raleigh, NC 27615

Phone

(919) 205-0520

NPI assigned

Aug 30, 2021

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 names 1

• Dr. Justin David Stacy Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1275200933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9660 FALLS OF NEUSE RD STE 153",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276152473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9660 FALLS OF NEUSE RD UNIT 153",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27615",
            "telephone_number": "919-205-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "JUSTIN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-30",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "13386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTIN",
            "last_name": "STACY",
            "middle_name": "DAVID",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Katie Lyn St. Pierre, PMHNP-BC, FNP-BC
• St' Ephraims Home Healthcare Services LLC
• Erin Stack, LPTA
• Kenneth P Stack, PT,MS,CSCS
• Annis Stacy
• Ryan K Staehling, D.D.S.
• Stephen J Stafford, MD
• Sydney Stafford, RN
• Katherine Elizabeth Stahl, DNP, AGPCNP-BC
• Rhonda Harris Stahl, M.D.

• Dentist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.