Healthcare Provider Details

I. General information

NPI: 1497518104
Provider Name (Legal Business Name): HERITAGE DENTAL CENTER - BUTTERMILK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 ANDERSON RD STE 100
CRESCENT SPRINGS KY
41017-1400
US

IV. Provider business mailing address

2446 ANDERSON RD STE 100
CRESCENT SPRINGS KY
41017-1400
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY REDDINGER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 859-991-7816