=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528386364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA SPARKS STEIN DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2010
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 MORTON BLVD
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-439-3557
-----------------------------------------------------
Fax | 606-439-1422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 ROSE STREET RM D104 UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40536-0297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-257-1494
-----------------------------------------------------
Fax | 859-257-5859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6494
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------