Provider Demographics
NPI:1477644920
Name:VANSTONE, SUSAN AMANTHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:AMANTHA
Last Name:VANSTONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice