Provider Demographics
NPI:1285766659
Name:ALLAART, STACEY MARIE (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:ALLAART
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:ZITTEL
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PC
Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6094
Mailing Address - Country:US
Mailing Address - Phone:480-598-5510
Mailing Address - Fax:480-598-5474
Practice Address - Street 1:4530 E RAY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6094
Practice Address - Country:US
Practice Address - Phone:480-598-5510
Practice Address - Fax:480-598-5474
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD45721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice