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NPI Code Detail

MEDICARE: CANDID KENTUCKY, PLLC

MEDICARE: CANDID KENTUCKY, PLLC
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1346857448
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANDID KENTUCKY, PLLC
Provider Business Mailing Address
First Line : 710 E MAIN ST
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-1668
Country : US
Telephone Number : 860-481-7631
Fax Number :
Provider Business Practice Location Address
First Line : 710 E MAIN ST
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-1668
Country : US
Telephone Number : 860-481-7631
Fax Number :
Authorized Official
Title or Position : DDS
Name : THOMAS SHANNON
Credential :
Telephone Number : 860-481-7631
Provider Enumeration Date : 09/23/2020
Last Update Date : 09/23/2020

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Directions to “CANDID KENTUCKY, PLLC ” Practice Location

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