MEDICARE: SUSAN A. VANSTONE DMD, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6913	KY

General Provider Information

NPI Number	:	1194816553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN A. VANSTONE DMD, PSC

Provider Business Mailing Address
First Line	:	1305 LANCASTER RD
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8745
Country	:	US
Telephone Number	:	859-626-9339
Fax Number	:	859-626-9336

Provider Business Practice Location Address
First Line	:	1305 LANCASTER RD
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8745
Country	:	US
Telephone Number	:	859-626-9339
Fax Number	:	859-626-9336

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SUSAN AMANTHA VANSTONE
Credential	:	D.M.D., P.S.C.
Telephone Number	:	859-626-9339

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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