# DENTAL SERVICES OF KENTUCKY, PSC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DENTAL SERVICES OF KENTUCKY, PSC
- **Other names:** ImmediaDent
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194238816
- **Legal business name:** DENTAL SERVICES OF KENTUCKY, PSC
- **Authorized official:** MONICA L LONG (MANAGER OF CREDENTIALING)
- **Authorized official phone:** (913) 428-1686

## Contact information

- **Practice address:** 2011 GRINSTEAD DR UNIT 102, LOUISVILLE, KY 40204-1296
- **Practice address phone:** (502) 638-2377
- **Practice address fax:** (913) 752-9116
- **Mailing address:** PO BOX 11568, OVERLAND PARK, KS 66207-4268
- **Mailing address phone:** (913) 428-1686
- **Mailing address fax:** (913) 752-9116

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2017
- **Last updated:** 11/16/2017