Provider Demographics
NPI:1902466329
Name:EARL, STETSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:STETSON
Middle Name:
Last Name:EARL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 HOUSTON RD STE 35
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4879
Mailing Address - Country:US
Mailing Address - Phone:859-371-0183
Mailing Address - Fax:
Practice Address - Street 1:7000 HOUSTON RD STE 35
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4879
Practice Address - Country:US
Practice Address - Phone:859-371-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11338411-99221223G0001X
OH30.0261761223G0001X
KY106471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice