Healthcare Provider Details

I. General information

NPI: 1811046337
Provider Name (Legal Business Name): MICHAEL EDWARD CHILD D.M.D., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2134 NICHOLASVILLE RD SUITE 13
LEXINGTON KY
40503-2521
US

IV. Provider business mailing address

2134 NICHOLASVILLE RD SUITE 13
LEXINGTON KY
40503-2521
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4449
  • Fax: 859-276-2228
Mailing address:
  • Phone: 859-276-4449
  • Fax: 859-276-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6279
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: