Healthcare Provider Details

I. General information

NPI: 1144029976
Provider Name (Legal Business Name): EMMA REISTER PURDOM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 SLICKBACK RD
BENTON KY
42025-7629
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-8441
  • Fax: 270-527-4187
Mailing address:
  • Phone: 859-323-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11337
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: