Healthcare Provider Details

I. General information

NPI: 1245669449
Provider Name (Legal Business Name): NORTHERN KENTUCKY DENTAL CENTERS-BUTTERMILK,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 ANDERSON RD SUIT ONE
CRESCENT SPRINGS KY
41017-1400
US

IV. Provider business mailing address

2446 ANDERSON RD SUIT ONE
CRESCENT SPRINGS KY
41017-1400
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-8200
  • Fax:
Mailing address:
  • Phone: 859-331-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY SASDRINIA
Title or Position: DENTIST
Credential: DMD
Phone: 858-801-4036