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General NPI Number Information
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NPI Number | 1346083276
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Entity Type | Organization
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Legal Business Name | HERITAGE DENTAL CENTER - PETERSBURG
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1930 PETERSBURG RD
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City | HEBRON
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State | KY
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Zip | 41048-8291
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Country | US
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Telephone | 859-441-3120
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Fax |
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Provider Business Mailing Address
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Address Line | 125 SAINT MICHAEL DR
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City | COLD SPRING
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State | KY
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Zip | 41076-3566
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Country | US
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Telephone | 859-441-3120
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMIN
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Name | BRITTANY REDDINGER
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Credential |
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Telephone | 859-441-3120
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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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