MR. STACY LEE BLACK DDS PA NPI 1063423085

NPI Information

  • NPI: 1063423085
  • Provider Name: MR. STACY LEE BLACK, DDS PA
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 132 HATCHETT ST.
    RUSK, TX
    ZIP 75785
  • Phone: (903) 683-5751

Map and Directions

Get Directions

NPI Details

MR. Stacy Lee Black, DDS PA is a general practice dentist in Rusk, TX. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MR. Stacy Lee Black, DDS PA NPI is 1063423085. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

132 HATCHETT ST.
RUSK, TX
ZIP 75785
Phone: (903) 683-5751
Fax: (903) 683-3455

The NPI 1063423085 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 8/11/2006 and was last updated on 5/28/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice17132TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
136871OTHERTEXASDENT
2009120901MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI