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NPI Code Detail

MEDICARE: DENTAL SERVICES OF KENTUCKY, PSC

MEDICARE: DENTAL SERVICES OF KENTUCKY, PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1194238816
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL SERVICES OF KENTUCKY, PSC
Provider Business Mailing Address
First Line : PO BOX 11568
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66207-4268
Country : US
Telephone Number : 913-428-1686
Fax Number : 913-752-9116
Provider Business Practice Location Address
First Line : 2011 GRINSTEAD DR UNIT 102
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1296
Country : US
Telephone Number : 502-638-2377
Fax Number : 913-752-9116
Authorized Official
Title or Position : MANAGER OF CREDENTIALING
Name : MONICA L LONG
Credential :
Telephone Number : 913-428-1686
Provider Enumeration Date : 11/16/2017
Last Update Date : 11/16/2017

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Directions to “DENTAL SERVICES OF KENTUCKY, PSC ” Practice Location

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