Healthcare Provider Details

I. General information

NPI: 1134250608
Provider Name (Legal Business Name): SWINTOSKY AND PETERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 LEAWOOD DR. SUITE 200
FRANKFORT KY
40601
US

IV. Provider business mailing address

1006 LEAWOOD DR. SUITE 200
FRANKFORT KY
40601
US

V. Phone/Fax

Practice location:
  • Phone: 502-223-0211
  • Fax: 502-875-5567
Mailing address:
  • Phone: 502-223-0211
  • Fax: 502-875-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7615
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5885
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7615
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5203
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3950
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6543
License Number StateKY

VIII. Authorized Official

Name: MR. DWIGHT PATRICK PETERS
Title or Position: CO-OWNER (CFO)
Credential: D.M.D
Phone: 502-223-0211