MEDICARE: MOUNT STERLING PEDIATRIC DENTISTRY 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
1	122300000X	Dentist	9326	KY
2	1223P0221X	Pediatric Dentistry	963	KY

General Provider Information

NPI Number	:	1780187583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT STERLING PEDIATRIC DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	2340 THISTLE PARK
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8568
Country	:	US
Telephone Number	:	606-465-1641
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E HIGH ST
Second Line	:
City	:	MOUNT STERLING
State	:	KY
Zip	:	40353-1267
Country	:	US
Telephone Number	:	606-465-1641
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. EMILEE YOUNG SEXTON
Credential	:	DMD
Telephone Number	:	606-465-1641

Provider Enumeration Date	:	03/18/2018
Last Update Date	:	03/18/2018

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