DR. STACY L BLACKMON DDS
NPI 1043334766
Dentist in Lake Wylie, SC

Q: What is Stacy Blackmon's NPI number?

The NPI number for Stacy Blackmon is 1043334766. It was assigned to this individual provider in the NPPES registry on March 19, 2007.

Q: What is Stacy Blackmon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Stacy Blackmon was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 19, 2007PECOS Enrolled

1100 VILLAGE HARBOR DR, LAKE WYLIE FAMILY DENTISTRY PA, LAKE WYLIE, SC 29710(803) 831-8856(803) 831-8966 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Stacy L Blackmon Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. STACY L BLACKMON DDS (NPI 1043334766) is an individual dentist in Lake Wylie, South Carolina, licensed in South Carolina (3673) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043334766

Entity TypeIndividualFemale

Primary Taxonomy122300000X

Provider Legal NameDR. STACY L BLACKMONCredential: DDS

Location Address1100 VILLAGE HARBOR DR, LAKE WYLIE FAMILY DENTISTRY PALake Wylie, SC 29710

Mailing Address1100 Village Harbor DrLake Wylie, SC 29710 · (803) 831-8856 · Fax (803) 831-8966

Phone(803) 831-8856

Fax(803) 831-8966

Sole ProprietorNo

Enumeration DateMarch 19, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1043334766 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in SC · 3673

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

1100 VILLAGE HARBOR DR, Lake Wylie, SC 29710

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Stacy L Blackmon Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29710 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.18 typical visit price

range $53.57 – $163.84

Typical copayment $20.79 (range $13.39 – $40.96)

Most-billed visit code 99203

Established Patient

$67.12 typical visit price

range $16.96 – $133.52

Typical copayment $16.78 (range $4.24 – $33.38)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KYLE RICHARD KILPATRICK II DMD

Dentist (General Practice)

1100 VILLAGE HARBOR DR
LAKE WYLIE, SC 29710

York County (803) 831-8856

DR. CHRISTOPHER ANDREW SNELL D.D.S.

Dentist

1100 VILLAGE HARBOR DR
LAKE WYLIE, SC 29710

York County (803) 831-8856

LAKE WYLIE FAMILY DENTISTRY PA

Dentist

1100 VILLAGE HARBOR DR
LAKE WYLIE, SC 29710

York County (803) 831-8856

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacy Blackmon's NPI number?

The NPI number for Stacy Blackmon is 1043334766. It was assigned to this individual provider in the NPPES registry on March 19, 2007.

Where is Stacy Blackmon located?

Stacy Blackmon practices at 1100 Village Harbor Dr Lake Wylie Family Dentistry PA, Lake Wylie, SC 29710. The listed phone number is (803) 831-8856.

What is Stacy Blackmon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Stacy Blackmon enrolled in Medicare?

Yes. Stacy Blackmon is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Stacy Blackmon was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.