# KENTUCKY DENTAL ANESTHESIA SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kentucky Dental Anesthesia Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013696723
- **Authorized official:** ERIC JACOBSON DMD (MEMBER)
- **Authorized official phone:** (859) 420-9187

## Contact information

- **Practice address:** 1006 ACE DR, BEREA, KY 40403-1327
- **Practice address phone:** (859) 420-9187
- **Mailing address:** 1006 ACE DR, BEREA, KY 40403-1327
- **Mailing address phone:** (859) 420-9187

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207LP3000X | Pediatric Anesthesiology Physician | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 07/12/2023
- **Last updated:** 10/30/2024