Healthcare Provider Details

I. General information

NPI: 1780187583
Provider Name (Legal Business Name): MOUNT STERLING PEDIATRIC DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 03/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E HIGH ST
MOUNT STERLING KY
40353-1267
US

IV. Provider business mailing address

2340 THISTLE PARK
LEXINGTON KY
40509-8568
US

V. Phone/Fax

Practice location:
  • Phone: 606-465-1641
  • Fax:
Mailing address:
  • Phone: 606-465-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9326
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number963
License Number StateKY

VIII. Authorized Official

Name: DR. EMILEE YOUNG SEXTON
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 606-465-1641