Healthcare Provider Details

I. General information

NPI: 1285942649
Provider Name (Legal Business Name): ERENA & PETERSON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 PERIMETER DR SUITE 100
LEXINGTON KY
40517-4125
US

IV. Provider business mailing address

620 PERIMETER DR SUITE 100
LEXINGTON KY
40517-4125
US

V. Phone/Fax

Practice location:
  • Phone: 859-268-4423
  • Fax: 859-268-0010
Mailing address:
  • Phone: 859-268-4423
  • Fax: 859-268-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON L. HINTON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 859-268-4423