Healthcare Provider Details

I. General information

NPI: 1720423197
Provider Name (Legal Business Name): DENTAL SLEEP MEDICINE OF NORTHERN KENTUCKY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7303 US HIGHWAY 42
FLORENCE KY
41042-1903
US

IV. Provider business mailing address

7303 US HIGHWAY 42
FLORENCE KY
41042-1903
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-1055
  • Fax: 859-283-1055
Mailing address:
  • Phone: 859-283-1055
  • Fax: 859-283-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7299
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7299
License Number StateKY

VIII. Authorized Official

Name: DR. MARC LEWIS MARLETTE
Title or Position: OWNER
Credential: D.M.D.
Phone: 859-283-1055