Healthcare Provider Details

I. General information

NPI: 1346083276
Provider Name (Legal Business Name): HERITAGE DENTAL CENTER - PETERSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 PETERSBURG RD
HEBRON KY
41048-8291
US

IV. Provider business mailing address

125 SAINT MICHAEL DR
COLD SPRING KY
41076-3566
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-3120
  • Fax:
Mailing address:
  • Phone: 859-441-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY REDDINGER
Title or Position: BUSINESS ADMIN
Credential:
Phone: 859-441-3120