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General NPI Number Information
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NPI Number | 1992505739
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Entity Type | Organization
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Legal Business Name | ELM PEDIATRIC DENTISTRY OF NORTHERN KENTUCKY PLLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1986 WALTON NICHOLSON PIKE
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City | INDEPENDENCE
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State | KY
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Zip | 41051-7906
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Country | US
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Telephone | 859-356-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 934 WOODLAND RIDGE CIR
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City | LA GRANGE
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State | KY
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Zip | 40031-1373
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Country | US
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Telephone | 270-572-9309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUSTIN RODENBERG
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Credential | DMD, MSD
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Telephone | 270-572-9309
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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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