Healthcare Provider Details

I. General information

NPI: 1902711385
Provider Name (Legal Business Name): KELTY MCLAURIN PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 ALEXANDRIA PIKE
HIGHLAND HEIGHTS KY
41076-1155
US

IV. Provider business mailing address

1809 ALEXANDRIA PIKE
HIGHLAND HEIGHTS KY
41076-1155
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-1500
  • Fax:
Mailing address:
  • Phone: 859-781-1500
  • 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: ELIZABETH KELTY MCLAURIN
Title or Position: DMD
Credential: DMD
Phone: 859-781-1500