Healthcare Provider Details

I. General information

NPI: 1528386364
Provider Name (Legal Business Name): PAMELA SPARKS STEIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA ANN VANARSDALL DMD

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MORTON BLVD
HAZARD KY
41701-9469
US

IV. Provider business mailing address

800 ROSE STREET RM D104 UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
LEXINGTON KY
40536-0297
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-3557
  • Fax: 606-439-1422
Mailing address:
  • Phone: 859-257-1494
  • Fax: 859-257-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6494
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: