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General NPI Number Information
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NPI Number | 1144029976
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Entity Type | Individual
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Provider Name | EMMA REISTER PURDOM DMD
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Gender | Female
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 267 SLICKBACK RD
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City | BENTON
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State | KY
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Zip | 42025-7629
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Country | US
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Telephone | 270-527-8441
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Fax | 270-527-4187
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Provider Business Mailing Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-7001
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Country | US
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Telephone | 859-323-1884
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11337
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License Number State | KY
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