Thora Jane Stacy, CDA EFDA

NPI #1245590553 in Salem, Oregon

Provider Information

NPI Number: 1245590553
Entity Type: Individual
Name: Thora Jane Stacy, CDA EFDA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Credential: CDA EFDA
Enumeration Date: May 21, 2012
Last Updated: May 21, 2012

Practice Location

Address: 2300 N.E. LACNCASTER DR.
City: Salem
State: Oregon
ZIP Code: 97303
Phone: (503) 370-4313

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Assistant	126800000X	Primary

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