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NPI Code Detail

MEDICARE: TATES CREEK DENTAL, PSC

MEDICARE: TATES CREEK DENTAL, 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 : 1225530660
Entity Type Code : Organization
Provider Name (Legal Business Name) : TATES CREEK DENTAL, PSC
Provider Business Mailing Address
First Line : 4071 TATES CREEK CENTRE DR STE 210
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-3094
Country : US
Telephone Number : 859-273-3139
Fax Number :
Provider Business Practice Location Address
First Line : 4071 TATES CREEK CENTRE DR STE 210
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-3094
Country : US
Telephone Number : 859-273-3139
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. JEFFREY KING
Credential : DMD
Telephone Number : 859-273-3139
Provider Enumeration Date : 03/01/2018
Last Update Date : 03/17/2018

Similar Medicare Providers

1043215536 — MRS. GRETCHEN B. CLIBURN PA-C
Practice Location Address:
4071 TATES CREEK CENTRE DR STE 202
LEXINGTON, KY
40517-3094
Practice Phone: 859-226-0206
Practice Fax:
1306848841 — MRS. KIRSTEN M ADAIR PA-C
Practice Location Address:
4071 TATES CREEK CENTRE DR STE 202
LEXINGTON, KY
40517-3094
Practice Phone: 859-226-0206
Practice Fax:
1124002811 — DEBORAH K PHILLIPS MD
Practice Location Address:
4071 TATES CREEK CENTRE DR STE 202
LEXINGTON, KY
40517-3094
Practice Phone: 859-226-0206
Practice Fax:
1669533295 — JULENA D ADAMS PA-C
Practice Location Address:
4071 TATES CREEK CENTRE DR STE 202
LEXINGTON, KY
40517-3094
Practice Phone: 859-226-0206
Practice Fax: 859-226-0207
1932486651 — LEXINGTON DERMATOLOGY & LASER CENTER PSC
Practice Location Address:
4071 TATES CREEK CENTRE DR STE 202
LEXINGTON, KY
40517-3094
Practice Phone: 859-226-0206
Practice Fax: 859-226-0207
1881036259 — SARAH MILLER DOUGHERTY PA-C
Practice Location Address:
4071 TATES CREEK CENTRE DR STE 202
LEXINGTON, KY
40517-3094
Practice Phone: 859-226-0206
Practice Fax: 859-226-0207

Directions to “TATES CREEK DENTAL, PSC ” Practice Location

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