Healthcare Provider Details

I. General information

NPI: 1659690766
Provider Name (Legal Business Name): JAIMIE DANIELLE RECTOR D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 WINCHESTER RD STE 225
LEXINGTON KY
40505-4132
US

IV. Provider business mailing address

1301 WINCHESTER RD
LEXINGTON KY
40505-4153
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-2552
  • Fax: 859-258-2552
Mailing address:
  • Phone: 859-258-2552
  • Fax: 859-258-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8879
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: