Healthcare Provider Details

I. General information

NPI: 1134271919
Provider Name (Legal Business Name): KELLY A ARNOLD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2393 ALUMNI DR SUITE 102
LEXINGTON KY
40517-4285
US

IV. Provider business mailing address

2393 ALUMNI DR SUITE 102
LEXINGTON KY
40517-4285
US

V. Phone/Fax

Practice location:
  • Phone: 859-268-8770
  • Fax: 859-268-8770
Mailing address:
  • Phone: 859-268-8770
  • Fax: 859-268-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7890
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7890
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: