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Organization
LISETTE BAECHTOLD, D.M.D., M.S.
Active
Organization
LISETTE BAECHTOLD, D.M.D., M.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESLIE LISETTE BAECHTOLD D.M.D., M.S. (DENTIST)
(859) 626-7977
Entity
Organization
Contact information
Practice address
2006 MERCHANT DR, RICHMOND, KY 40475-8167
(859) 626-7977
(859) 626-5103
Mailing address
2006 MERCHANT DR, RICHMOND, KY 40475-8167
(859) 626-7977
(859) 626-5103
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6635
KY
1223G0001X
General Practice Dentistry
Primary
6635
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1603579
UNITED CONCORDIA
KY
05
—
45004306
—
KY
05
—
60066354
—
KY
Enumeration date
10/05/2006
Last updated
07/28/2009
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