Individual
MRS. STACY M BRANTHOOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
195 W COUNTY ROAD 600 S, CLAYTON, IN 46118-9295
(317) 777-0142
Mailing address
195 W COUNTY ROAD 600 S, CLAYTON, IN 46118-9295
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13006296A
IN
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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