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General NPI Number Information
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NPI Number | 1629294319
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Entity Type | Individual
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Provider Name | MOHAMMAD JAY SADRINIA DMD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 2446 ANDERSON RD
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City | CRESCENT SPRINGS
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State | KY
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Zip | 41017-1400
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Country | US
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Telephone | 859-344-9222
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Fax | 859-344-1490
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Provider Business Mailing Address
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Address Line | 2446 ANDERSON RD
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City | CRESCENT SPRINGS
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State | KY
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Zip | 41017-1400
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Country | US
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Telephone | 859-331-8200
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Fax | 859-331-0456
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6596
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License Number State | KY
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