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General NPI Number Information
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NPI Number | 1396545083
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Entity Type | Organization
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Legal Business Name | BRECKENRIDGE DENTAL, PSC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3348 HIKES LN STE 107
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City | LOUISVILLE
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State | KY
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Zip | 40220-2000
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Country | US
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Telephone | 502-451-5222
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Fax | 502-451-5263
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Provider Business Mailing Address
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Address Line | 3348 HIKES LN STE 107
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City | LOUISVILLE
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State | KY
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Zip | 40220-2000
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Country | US
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Telephone | 502-451-5222
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Fax | 502-451-5263
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Authorized Official
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Title or Position | OWNER
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Name | JEFF KING
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Credential | DMD
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Telephone | 502-451-5222
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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