Healthcare Provider Details

I. General information

NPI: 1972606051
Provider Name (Legal Business Name): KENTUCKY CENTER FOR ORTHODONTICS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 CORPORATE DR STE. 201
LEXINGTON KY
40503-5425
US

IV. Provider business mailing address

860 CORPORATE DR STE. 201
LEXINGTON KY
40503-5425
US

V. Phone/Fax

Practice location:
  • Phone: 859-223-3939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN HUANG
Title or Position: VP/SEC/TREAS
Credential:
Phone: 859-223-3939