Stacy Ann Ackerman, D.D.S., M.M.SC.
Individual provider Active NPI Dentist · Dillon, CO
NPI 1891862850 · NPPES record last updated Jul 23, 2007
Key facts
- NPI
- 1891862850
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8624 (CO)
- Practice address
- 325 Lake Dillon Drive
Suite 203
Dillon, CO 80435-2949 - Phone
- (970) 262-7664
- Fax
- (970) 262-7604
- NPI assigned
- Nov 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8624 | CO | MD | Dentist |
| 21556 | MA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8624 | CO | Yes |
| Dentist | 122300000X | 21556 | MA |
Addresses
Primary practice location
325 Lake Dillon Drive
Suite 203
Dillon, CO 80435-2949
Mailing address
PO Box 2949
Dillon, CO 80435-2949
Phone (970) 262-7664
Other names
- Stacy Ann Henderson
Other providers in Dillon, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.