Healthcare Provider Details

I. General information

NPI: 1710058862
Provider Name (Legal Business Name): JOHN FREDRIC DENISON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 REGENCY RD
LEXINGTON KY
40503-2309
US

IV. Provider business mailing address

2036 REGENCY RD
LEXINGTON KY
40503-2309
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-6234
  • Fax: 859-276-3726
Mailing address:
  • Phone: 859-277-6234
  • Fax: 859-276-3726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5309
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: