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General NPI Number Information
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NPI Number | 1063576031
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Entity Type | Organization
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Legal Business Name | DENTAL CARE OF KENTUCKY - DR O.CRAIG SHANTEAU, DDS, PSC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4097 NICHOLS PARK DR SUITE 108
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City | LEXINGTON
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State | KY
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Zip | 40503-4428
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Country | US
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Telephone | 859-971-9298
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Fax | 859-971-9603
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Provider Business Mailing Address
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Address Line | 4097 NICHOLS PARK DR SUITE 108
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City | LEXINGTON
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State | KY
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Zip | 40503-4428
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Country | US
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Telephone | 859-971-9298
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Fax | 859-971-9603
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Authorized Official
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Title or Position | INS COOD
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Name | AMY M KROEGER
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Credential |
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Telephone | 217-540-5100
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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 |
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License Number State |
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