Provider Demographics
NPI:1376637207
Name:HUDDLESTON, STEPHANIE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:HUDDLESTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2541 SIR BARTON WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2292
Mailing Address - Country:US
Mailing Address - Phone:859-543-0444
Mailing Address - Fax:859-543-0454
Practice Address - Street 1:2541 SIR BARTON WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2292
Practice Address - Country:US
Practice Address - Phone:859-543-0444
Practice Address - Fax:859-543-0454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice