1972606051 NPI number — KENTUCKY CENTER FOR ORTHODONTICS, PSC

Table of content: (NPI 1972606051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972606051 NPI number — KENTUCKY CENTER FOR ORTHODONTICS, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY CENTER FOR ORTHODONTICS, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972606051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 CORPORATE DR
Provider Second Line Business Mailing Address:
STE. 201
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-5425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 CORPORATE DR
Provider Second Line Business Practice Location Address:
STE. 201
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-5425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-223-3939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUANG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/SEC/TREAS
Authorized Official Telephone Number:
859-223-3939

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60052388 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com