MEDICARE: GARDEN SPRINGS DRE, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1386351146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN SPRINGS DRE, LLC

Provider Business Mailing Address
First Line	:	105 SPRUCE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40507-2109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 LANE ALLEN RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3605
Country	:	US
Telephone Number	:	859-277-1189
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GREG WHITE
Credential	:
Telephone Number	:	859-533-1109

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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