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Organization
DENTAL SERVICES OF KENTUCKY, PSC
Active
Organization
DENTAL SERVICES OF KENTUCKY, PSC
Active
Parent organization
DENTAL SERVICES OF KENTUCKY, PSC
Other names
Immediadent
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL SERVICES OF KENTUCKY, PSC
Authorized official
MONICA L LONG (MANAGER OF PROVIDER CREDENTIALING)
(913) 428-1686
Entity
Organization
Contact information
Practice address
3946 TAYLORSVILLE RD., LOUISVILLE, KY 40220
(502) 276-8950
(866) 591-0604
Mailing address
PO BOX 11568, OVERLAND PARK, KS 66207
(913) 428-1686
(866) 591-0604
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71002245080
—
KY
Enumeration date
05/14/2015
Last updated
05/01/2017
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