Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Wylie Family Dentistry PA

Organization Dentist · NPI 1437370798

Lake Wylie Family Dentistry PA is a Dentist in Lake Wylie, South Carolina. Licensed in South Carolina. Registered with an NPI since 2007.

Licensed in
SC
In the registry since
2007
Specialties on file
2
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

1100 Village Harbor Dr
Lake Wylie, SC 29710
Phone: (803) 831-8856
Fax: (803) 831-8966
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 2830 (SC)
Dentist Taxonomy 122300000X · Licence 3673 (SC)

Record details

NPI number1437370798
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Susan Stall — Insurance Dept · (803) 831-8856
Other names Dr Thomas N Stall Dmd Or Dr Stacy L Blackmon Dds
NPI enumeratedMay 2, 2007
Last updated in NPPESFebruary 4, 2008
Mailing addressPo Box 5248, Lake Wylie, SC 29710

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