Healthcare Provider Details

I. General information

NPI: 1083807945
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CHAMPION WAY SUITE 9
GEORGETOWN KY
40324-8862
US

IV. Provider business mailing address

216 FOUNTAIN CT SUITE#150
LEXINGTON KY
40509-1888
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-9300
  • Fax:
Mailing address:
  • Phone: 859-543-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ERIN GOBBLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 502-868-9300