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General NPI Number Information
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NPI Number | 1447331509
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF GEORGETOWN, PLLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 101 DARBY DR STE 101
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City | GEORGETOWN
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State | KY
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Zip | 40324-8715
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Country | US
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Telephone | 502-867-0451
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Fax | 502-867-0458
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Provider Business Mailing Address
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Address Line | 101 DARBY DR STE 101
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City | GEORGETOWN
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State | KY
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Zip | 40324-8715
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Country | US
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Telephone | 502-867-0451
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Fax | 502-867-0458
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER A COTTERILL
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Credential | D.M.D.
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Telephone | 502-867-0451
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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 | 754
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7468
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License Number State | KY
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