Healthcare Provider Details

I. General information

NPI: 1679206635
Provider Name (Legal Business Name): RODNEY LEDFORD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HIGHWAY 80
MANCHESTER KY
40962-8801
US

IV. Provider business mailing address

876 PHILPOT ROAD
LONDON KY
40744
US

V. Phone/Fax

Practice location:
  • Phone: 606-596-0410
  • Fax: 606-598-1117
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number10828
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: