Healthcare Provider Details

I. General information

NPI: 1629294319
Provider Name (Legal Business Name): MOHAMMAD JAY SADRINIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 ANDERSON RD
CRESCENT SPRINGS KY
41017-1400
US

IV. Provider business mailing address

2446 ANDERSON RD
CRESCENT SPRINGS KY
41017-1400
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-9222
  • Fax: 859-344-1490
Mailing address:
  • Phone: 859-331-8200
  • Fax: 859-331-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6596
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: