Provider Demographics
NPI:1194816553
Name:SUSAN A. VANSTONE DMD, PSC
Entity Type:Organization
Organization Name:SUSAN A. VANSTONE DMD, PSC
Other - Org Name:GREAT GRINS DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:AMANTHA
Authorized Official - Last Name:VANSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PSC
Authorized Official - Phone:859-626-9339
Mailing Address - Street 1:1305 LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8745
Mailing Address - Country:US
Mailing Address - Phone:859-626-9339
Mailing Address - Fax:859-626-9336
Practice Address - Street 1:1305 LANCASTER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8745
Practice Address - Country:US
Practice Address - Phone:859-626-9339
Practice Address - Fax:859-626-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty