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General NPI Number Information
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NPI Number | 1104918945
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Entity Type | Individual
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Provider Name | KELLY J CHRISCO DMD
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 4384 CLEARWATER WAY STE 150
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City | LEXINGTON
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State | KY
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Zip | 40515
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Country | US
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Telephone | 859-317-6810
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Fax |
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Provider Business Mailing Address
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Address Line | 4384 CLEARWATER WAY STE 150 150
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City | LEXINGTON
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State | KY
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Zip | 40515
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Country | US
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Telephone | 859-317-6810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 8238
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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 | 8238
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8238
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License Number State | KY
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