Healthcare Provider Details

I. General information

NPI: 1043823586
Provider Name (Legal Business Name): RACHAD KUDSI BDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST LEXINGTON KY
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

1435 NICHOLASVILLE RD APT 2206
LEXINGTON KY
40503-1191
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6193
  • Fax:
Mailing address:
  • Phone: 352-216-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10348
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: