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General NPI Number Information
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NPI Number | 1568006146
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Entity Type | Organization
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Legal Business Name | JUSTICE DENTAL BLAZER PLLC
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 3285 BLAZER PKWY STE 200
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City | LEXINGTON
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State | KY
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Zip | 40509-2119
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Country | US
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Telephone | 859-543-0700
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Fax | 859-543-1078
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Provider Business Mailing Address
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Address Line | 3285 BLAZER PKWY STE 200
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City | LEXINGTON
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State | KY
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Zip | 40509-2119
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Country | US
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Telephone | 859-543-0700
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Fax | 859-543-1078
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MRS. LAURA LYNN SISLER
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Credential |
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Telephone | 859-543-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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