Healthcare Provider Details

I. General information

NPI: 1871695528
Provider Name (Legal Business Name): LAURIE C FORD D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 HIGHWAY 44 E STE 140
MT WASHINGTON KY
40047-6707
US

IV. Provider business mailing address

PO BOX 316
MT WASHINGTON KY
40047-0316
US

V. Phone/Fax

Practice location:
  • Phone: 502-538-8881
  • Fax: 502-416-0748
Mailing address:
  • Phone: 502-538-8881
  • Fax: 502-416-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8412
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: