Healthcare Provider Details

I. General information

NPI: 1538093273
Provider Name (Legal Business Name): VICTORIA RAEANN BONE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-3301
US

IV. Provider business mailing address

13320 CONDUCTOR CIR APT 412
LOUISVILLE KY
40243-2451
US

V. Phone/Fax

Practice location:
  • Phone: 270-390-0006
  • Fax:
Mailing address:
  • Phone: 316-680-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-00229
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: