Healthcare Provider Details

I. General information

NPI: 1659610269
Provider Name (Legal Business Name): KIDS DENTISTRY- DIXIE HIGHWAY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 DIXIE HWY B
LOUISVILLE KY
40272-3939
US

IV. Provider business mailing address

9707 DIXIE HWY B
LOUISVILLE KY
40272-3939
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-7363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KATHIE ARMSTRONG
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 502-254-8501