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General NPI Number Information
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NPI Number | 1528217940
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Entity Type | Individual
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Provider Name | STEPHANIE L WETZEL DDS
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Gender | Female
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 290 BIG RUN RD
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City | LEXINGTON
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State | KY
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Zip | 40503-2903
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Country | US
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Telephone | 859-278-9513
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Fax |
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Provider Business Mailing Address
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Address Line | 290 BIG RUN RD
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City | LEXINGTON
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State | KY
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Zip | 40503-2903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 11045
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN015296
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | DN015296
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License Number State | GA
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