MEDICARE: DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1104753599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C.

Provider Business Mailing Address
First Line	:	3948 FOUNTAINBLUE LN STE 110
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-8315
Country	:	US
Telephone Number	:	859-222-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 FOUNTAINBLUE LN STE 110
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-8315
Country	:	US
Telephone Number	:	859-222-8995
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	CEMYIRA MCDOUGAL
Credential	:
Telephone Number	:	217-764-8609

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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