1154828176 NPI number — SCHULTEN PEDIATRIC DENTISTRY FRANKFORT LLC

Table of content: (NPI 1154828176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154828176 NPI number — SCHULTEN PEDIATRIC DENTISTRY FRANKFORT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHULTEN PEDIATRIC DENTISTRY FRANKFORT LLC
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:
FRANKFORT PEDIATRIC DENTISTRY
Provider Other Organization Name Type Code:
3
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:
1154828176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 C MICHAEL DAVENPORT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40601-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-223-7186
Provider Business Mailing Address Fax Number:
502-223-2514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 C MICHAEL DAVENPORT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-223-7186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTEN
Authorized Official First Name:
JENNA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-223-7186

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  8868 , 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)





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