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General NPI Number Information
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NPI Number | 1245374172
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 216 FOUNTAIN CT SUITE#150
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City | LEXINGTON
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State | KY
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Zip | 40509-1888
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Country | US
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Telephone | 859-543-2242
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 IVAL JAMES BLVD SUITE C
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City | RICHMOND
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State | KY
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Zip | 40475-8174
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Country | US
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Telephone | 859-626-9620
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI A KORETSKI
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Credential |
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Telephone | 859-543-2242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4500027000
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License Number State | KY
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