Healthcare Provider Details

I. General information

NPI: 1407075088
Provider Name (Legal Business Name): GENTLE CARE FAMILY COSMETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2558 LARKIN RD
LEXINGTON KY
40503-3205
US

IV. Provider business mailing address

2558 LARKIN RD
LEXINGTON KY
40503-3205
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-1151
  • Fax:
Mailing address:
  • Phone: 859-277-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number7403
License Number StateKY

VIII. Authorized Official

Name: FAHED HISHMEH
Title or Position: DENTIST
Credential:
Phone: 859-277-1151