# PEDIATRIC DENTISTRY OF OLDHAM COUNTYQ

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033555982
- **Authorized official:** DR. TRACY LEANN KIM DMD,MBA (DENTISTR/OWNER)
- **Authorized official phone:** (502) 222-8848

## Contact information

- **Practice address:** 1000 BUCKNER CTR, SUITE 3, LA GRANGE, KY 40031-7790
- **Practice address phone:** (502) 222-8848
- **Practice address fax:** (502) 222-9319
- **Mailing address:** 1000 BUCKNER CTR, SUITE 3, LA GRANGE, KY 40031-7790
- **Mailing address phone:** (502) 222-8848
- **Mailing address fax:** (502) 222-9319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7129 | KY | Yes |

## Other

- **Enumeration date:** 05/20/2013
- **Last updated:** 05/20/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1538156849 | PROVIDER NPI | — |