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General NPI Number Information
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NPI Number | 1174235584
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Entity Type | Organization
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Legal Business Name | FDC GEORGETOWN PLLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 723 BUTTERMILK PIKE
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City | CRESCENT SPRINGS
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State | KY
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Zip | 41017-1304
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Country | US
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Telephone | 859-431-3900
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Fax | 859-431-5405
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Provider Business Mailing Address
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Address Line | 1006 LEAWOOD DR STE 200
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City | FRANKFORT
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State | KY
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Zip | 40601-3523
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Country | US
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Telephone | 502-295-2074
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Fax | 502-875-5567
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Authorized Official
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Title or Position | CEO
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Name | DR. DWIGHT PATRICK PETERS
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Credential | MD
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Telephone | 22-952-0745
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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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