MEDICARE: DR. STACEY GRAHAM KRESS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6944	KY
2	122300000X	Dentist	DN13798	FL

General Provider Information

NPI Number	:	1598255119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY GRAHAM KRESS DMD

Provider Business Mailing Address
First Line	:	1717 N BAYSHORE DR APT 1736
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-1154
Country	:	US
Telephone Number	:	859-619-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E REYNOLDS RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1245
Country	:	US
Telephone Number	:	859-619-7990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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