Healthcare Provider Details

I. General information

NPI: 1700577541
Provider Name (Legal Business Name): DENTAL IMPLANT SPECIALISTS OF KENTUCKY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SAINT MICHAEL DR
COLD SPRING KY
41076-3566
US

IV. Provider business mailing address

3500 MAPLE AVE STE 1600
DALLAS TX
75219-3936
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-3120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: RIAD ALMASRI
Title or Position: OWNER DENTIST
Credential:
Phone: 469-688-5555