Provider Demographics
NPI:1598255119
Name:KRESS, STACEY GRAHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:GRAHAM
Last Name:KRESS
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 1:1717 N BAYSHORE DR APT 1736
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1154
Mailing Address - Country:US
Mailing Address - Phone:859-619-7990
Mailing Address - Fax:
Practice Address - Street 1:200 E REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1245
Practice Address - Country:US
Practice Address - Phone:859-619-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6944122300000X
FLDN13798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist