Healthcare Provider Details

I. General information

NPI: 1801625496
Provider Name (Legal Business Name): AMY KALYN STAPLES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY KALYN LEHMANN RDH

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WAPPOO CREEK DR STE 5
CHARLESTON SC
29412-2136
US

IV. Provider business mailing address

1952 ZONNY MOSS DR
JOHNS ISLAND SC
29455-8331
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-1234
  • Fax:
Mailing address:
  • Phone: 832-656-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12597
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: