| Ids Smile Lab | |
|
541 Darby Creek Road Ste 190 Lexington KY 40509 | |
| (859) 287-2484 | |
| (859) 287-2484 |
| Full Name | Ids Smile Lab |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 541 Darby Creek Road, Lexington, Kentucky |
| Authorized Official Name and Position | Brandon M Stapleton (DENTIST/OWNER) |
| Authorized Official Contact | 8592872484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ids Smile Lab 541 Darby Creek Road Ste 190 Lexington KY 40509 Ph: (859) 287-2484 | Ids Smile Lab 541 Darby Creek Road Ste 190 Lexington KY 40509 Ph: (859) 287-2484 |
| NPI Number | 1760975650 |
|---|---|
| Provider Enumeration Date | 06/14/2018 |
| Last Update Date | 01/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760975650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 9038 (Kentucky) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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