Stacy Black, DDS, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17132 Issued in TX

Legal business name

STACY BLACK, DDS, PA

Practice address

132 Hatchett
Rusk, TX 75785

Phone

(903) 683-5751

NPI assigned

Mar 31, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Stacy Lee Black, DDSNPI 1063423085

Title

Member/President

Phone

(903) 683-5751

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy Lee Black, DDS PA

  • General Practice Dentistry
  • Rusk, TX
  • NPI 1063423085
  NPD (past) Authorized official

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1831584598",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 HATCHETT",
            "city": "RUSK",
            "state": "TX",
            "postal_code": "75785",
            "telephone_number": "903-683-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACY BLACK, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MEMBER/PRESIDENT",
        "authorized_official_telephone_number": "903-683-5751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "17132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Ellen Session
• Alea Lynn Simpson, LPC
• Solus Christus Transportation
• Sound Minds PLLC
• Lakshmi Srinivasan, FNP
• Ma Camille Tabtab, PMHNP-BC
• Cassie Jean Thacker
• Lisa Kathryn Trawick, NP
• Gerard Vallejo, M.D.
• Kendra R Verhelle, MD

• 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 Mar 31, 2015; 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.