=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194816553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN A. VANSTONE DMD, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 LANCASTER RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-8745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-626-9339
-----------------------------------------------------
Fax | 859-626-9336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 LANCASTER RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-8745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-626-9339
-----------------------------------------------------
Fax | 859-626-9336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. SUSAN AMANTHA VANSTONE
-----------------------------------------------------
Credential | D.M.D., P.S.C.
-----------------------------------------------------
Telephone | 859-626-9339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6913
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------