# LISETTE BAECHTOLD, D.M.D., M.S.

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

## Provider details

- **NPI number:** 1063508398
- **Authorized official:** MRS. LESLIE LISETTE BAECHTOLD D.M.D., M.S. (DENTIST)
- **Authorized official phone:** (859) 626-7977

## Contact information

- **Practice address:** 2006 MERCHANT DR, RICHMOND, KY 40475-8167
- **Practice address phone:** (859) 626-7977
- **Practice address fax:** (859) 626-5103
- **Mailing address:** 2006 MERCHANT DR, RICHMOND, KY 40475-8167
- **Mailing address phone:** (859) 626-7977
- **Mailing address fax:** (859) 626-5103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6635 | KY | — |
| 1223G0001X | General Practice Dentistry | 6635 | KY | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 07/28/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1603579 | UNITED CONCORDIA | KY |
| 05 | — | 45004306 | — | KY |
| 05 | — | 60066354 | — | KY |