MEDICARE: A PLUS FAMILY DENTISTRY

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1205334778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLUS FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	3122 CUSTER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4000
Country	:	US
Telephone Number	:	859-273-2224
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 CUSTER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4000
Country	:	US
Telephone Number	:	859-273-2224
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	MRS. NORA ELAINE PENNINGTON
Credential	:	OWNER/PARTNER
Telephone Number	:	859-273-2224

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	01/30/2018

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Directions to “A PLUS FAMILY DENTISTRY ” Practice Location

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