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General NPI Number Information
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NPI Number | 1518599802
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Entity Type | Organization
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Legal Business Name | DERBY CITY PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 2120 HIGH WICKHAM PL STE 103
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City | LOUISVILLE
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State | KY
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Zip | 40245-5903
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Country | US
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Telephone | 502-254-6097
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Fax | 502-254-6098
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Provider Business Mailing Address
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Address Line | 2120 HIGH WICKHAM PL STE 103
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City | LOUISVILLE
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State | KY
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Zip | 40245-5903
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Country | US
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Telephone | 502-254-6097
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Fax | 502-254-6098
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Authorized Official
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Title or Position | OWNER, PEDIATRIC DENTIST
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Name | DR. KORIE DUNHOFT ACORD
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Credential | DMD
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Telephone | 502-254-6097
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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 |
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License Number State |
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