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General NPI Number Information
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NPI Number | 1043090673
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Entity Type | Organization
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Legal Business Name | KELLY MOORE MEADOR, DMD PLLC
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 5150 TAYLOR MILL RD
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City | TAYLOR MILL
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State | KY
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Zip | 41015-2158
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Country | US
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Telephone | 859-491-3411
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Fax | 859-491-3417
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Provider Business Mailing Address
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Address Line | 5150 TAYLOR MILL RD
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City | TAYLOR MILL
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State | KY
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Zip | 41015-2158
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Country | US
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Telephone | 859-491-3411
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Fax | 859-491-3417
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KELLY SUZANN MOORE MEADOR
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Credential | DMD
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Telephone | 859-322-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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