Provider Demographics
NPI:1801625496
Name:STAPLES, AMY KALYN (RDH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KALYN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KALYN
Other - Last Name:LEHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1952 ZONNY MOSS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8331
Mailing Address - Country:US
Mailing Address - Phone:832-656-9887
Mailing Address - Fax:
Practice Address - Street 1:113 WAPPOO CREEK DR STE 5
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2136
Practice Address - Country:US
Practice Address - Phone:843-762-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12597124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist