1821248162 NPI number — DENTAL SERVICES OF KENTUCKY, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821248162 NPI number — DENTAL SERVICES OF KENTUCKY, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL SERVICES OF KENTUCKY, 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:
6
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:
1821248162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11568
Provider Second Line Business Mailing Address:
STE 155
Provider Business Mailing Address City Name:
OVERLAND
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207-4268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-428-1674
Provider Business Mailing Address Fax Number:
866-591-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2358 NICHOLASVILLE RD
Provider Second Line Business Practice Location Address:
#156
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-381-0680
Provider Business Practice Location Address Fax Number:
859-381-0633
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
913-800-6952

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100058850 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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