MEDICARE: BUTTERMILK FAMILY AND COSMETIC 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1659594042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTERMILK FAMILY AND COSMETIC DENTISTRY

Provider Business Mailing Address
First Line	:	2325 BUTTERMILK XING
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1622
Country	:	US
Telephone Number	:	859-344-9222
Fax Number	:	859-344-1490

Provider Business Practice Location Address
First Line	:	2325 BUTTERMILK XING
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1622
Country	:	US
Telephone Number	:	859-344-9222
Fax Number	:	859-344-1490

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MOLLY A DICKHAUS
Credential	:
Telephone Number	:	859-344-9222

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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