Healthcare Provider Details

I. General information

NPI: 1770975047
Provider Name (Legal Business Name): DUPLESSIS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RING RD
ELIZABETHTOWN KY
42701-7941
US

IV. Provider business mailing address

2401 RING RD
ELIZABETHTOWN KY
42701-7941
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-6502
  • Fax: 270-766-1988
Mailing address:
  • Phone: 270-765-6502
  • Fax: 270-766-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ELIZABETH DUPLESSIS WATERS
Title or Position: ORTHODONTICS
Credential: DDS
Phone: 270-765-6502