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General NPI Number Information
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NPI Number | 1063508398
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Entity Type | Organization
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Legal Business Name | LISETTE BAECHTOLD, D.M.D., M.S.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 2006 MERCHANT DR
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City | RICHMOND
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State | KY
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Zip | 40475-8167
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Country | US
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Telephone | 859-626-7977
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Fax | 859-626-5103
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Provider Business Mailing Address
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Address Line | 2006 MERCHANT DR
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City | RICHMOND
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State | KY
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Zip | 40475-8167
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Country | US
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Telephone | 859-626-7977
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Fax | 859-626-5103
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. LESLIE LISETTE BAECHTOLD
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Credential | D.M.D., M.S.
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Telephone | 859-626-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6635
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6635
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License Number State | KY
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