Healthcare Provider Details

I. General information

NPI: 1861781031
Provider Name (Legal Business Name): BRANDON MORRIS STAPLETON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 DARBY CREEK ROAD STE 190
LEXINGTON KY
40509-1701
US

IV. Provider business mailing address

541 DARBY CREEK ROAD SUITE 190
LEXINGTON KY
40509-2710
US

V. Phone/Fax

Practice location:
  • Phone: 859-287-2484
  • Fax: 859-287-2463
Mailing address:
  • Phone: 606-205-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9038
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: