Healthcare Provider Details

I. General information

NPI: 1821248162
Provider Name (Legal Business Name): DENTAL SERVICES OF KENTUCKY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 NICHOLASVILLE RD #156
LEXINGTON KY
40503-3032
US

IV. Provider business mailing address

PO BOX 11568 STE 155
OVERLAND KS
66207-4268
US

V. Phone/Fax

Practice location:
  • Phone: 859-381-0680
  • Fax: 859-381-0633
Mailing address:
  • Phone: 913-428-1674
  • Fax: 866-591-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY WHEELER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 913-800-6952