Provider Demographics
NPI:1528386364
Name:STEIN, PAMELA SPARKS (DMD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SPARKS
Last Name:STEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:VANARSDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:800 ROSE STREET RM D104
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-257-1494
Mailing Address - Fax:859-257-5859
Practice Address - Street 1:750 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9469
Practice Address - Country:US
Practice Address - Phone:606-439-3557
Practice Address - Fax:606-439-1422
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60064946Medicaid