IDS SMILE LAB – NPI #1760975650
Clinic/Center

IDS SMILE LAB is an AHC clinic located in LEXINGTON, KY. NPPES has assigned the NPI number 1760975650 to IDS SMILE LAB on June 14, 2018. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “IDS SMILE LAB” is a dba name, the actual legal business name for this organization is IDENTITY DENTAL STUDIO, PLLC. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was previously updated about 6 years ago on Jan 16, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for IDS SMILE LAB below.

NPI Profile for
IDENTITY DENTAL STUDIO, PLLC

NPI Number
1760975650
Enumeration Date

(about 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
IDENTITY DENTAL STUDIO, PLLC
Doing Business As (dba): IDS SMILE LAB
Primary location
541 DARBY CREEK ROAD
STE 190
LEXINGTON, KY 40509
Phone: (859) 287-2484 Fax: (859) 287-2484
Mailing address
Same as primary location
Organization Subpart
Yes - IDS SMILE LAB is subpart of another organization.
Authorized Official
BRANDON STAPLETON
DENTIST/OWNER
Phone: (859) 287-2484
Updated
Certification Date
Jan 16, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)
1223P0700X
- Dentist / Prosthodontics
KY 9038

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.