Healthcare Provider Details

I. General information

NPI: 1265301360
Provider Name (Legal Business Name): NKY2 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 S FORT THOMAS AVE
FORT THOMAS KY
41075-2453
US

IV. Provider business mailing address

1463 S FORT THOMAS AVE
FORT THOMAS KY
41075-2453
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-4000
  • Fax:
Mailing address:
  • Phone: 859-781-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA GRAMMER
Title or Position: OM
Credential:
Phone: 502-319-3854