# INTERIM DENT PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Hills Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306499082
- **Authorized official:** JINYOUNG KIM DMD (OWNER)
- **Authorized official phone:** (859) 273-5020

## Contact information

- **Practice address:** 3122 CUSTER DR, LEXINGTON, KY 40517-4000
- **Practice address phone:** (859) 273-5020
- **Practice address fax:** (859) 245-2219
- **Mailing address:** 3122 CUSTER DR, LEXINGTON, KY 40517-4000
- **Mailing address phone:** (859) 273-5020
- **Mailing address fax:** (859) 245-2219

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 07/22/2019
- **Last updated:** 01/18/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100482030 | — | KY |