Healthcare Provider Details

I. General information

NPI: 1942474069
Provider Name (Legal Business Name): KAY M ESCHELBACH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA KAY ESCHELBACH DMD

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 EDGEWOOD DRIVE
NICHOLASVILLE KY
40356
US

IV. Provider business mailing address

621 EDGEWOOD DRIVE
NICHOLASVILLE KY
40356
US

V. Phone/Fax

Practice location:
  • Phone: 859-885-4621
  • Fax: 859-887-0375
Mailing address:
  • Phone: 859-885-4621
  • Fax: 859-887-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5774
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: