Healthcare Provider Details

I. General information

NPI: 1184729873
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 IVAL JAMES BLVD SUITE C
RICHMOND KY
40475-8174
US

IV. Provider business mailing address

1012 IVAL JAMES BLVD SUITE C
RICHMOND KY
40475-8174
US

V. Phone/Fax

Practice location:
  • Phone: 859-626-9620
  • Fax: 859-626-9622
Mailing address:
  • Phone: 859-626-9620
  • Fax: 859-626-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ERIN GOBBLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 859-626-9620