Provider Demographics
NPI:1235651803
Name:APPALACHIAN PERIODONTICS
Entity Type:Organization
Organization Name:APPALACHIAN PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:DF
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-422-9176
Mailing Address - Street 1:419 TOWN MOUNTAIN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1633
Mailing Address - Country:US
Mailing Address - Phone:606-422-9176
Mailing Address - Fax:606-437-9886
Practice Address - Street 1:419 TOWN MOUNTAIN RD STE 201
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1633
Practice Address - Country:US
Practice Address - Phone:606-422-9176
Practice Address - Fax:606-437-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY95371223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty