Healthcare Provider Details

I. General information

NPI: 1184321119
Provider Name (Legal Business Name): DEBORA LOPES SALLES SCHEFFEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 08/08/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE A201
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2200 TRACERY OAKS DR APT 3206
LEXINGTON KY
40514-8309
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6261
  • Fax: 859-323-2036
Mailing address:
  • Phone: 706-373-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10864
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: