# 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:** 1376921098
- **Legal business name:** DENTAL SERVICES OF KENTUCKY, PSC
- **Authorized official:** MONICA L LONG (MANAGER OF PROVIDER CREDENTIALING)
- **Authorized official phone:** (913) 428-1686

## Contact information

- **Practice address:** 3946 TAYLORSVILLE RD., LOUISVILLE, KY 40220
- **Practice address phone:** (502) 276-8950
- **Practice address fax:** (866) 591-0604
- **Mailing address:** PO BOX 11568, OVERLAND PARK, KS 66207
- **Mailing address phone:** (913) 428-1686
- **Mailing address fax:** (866) 591-0604

## Taxonomy

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

## Other

- **Enumeration date:** 05/14/2015
- **Last updated:** 05/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 71002245080 | — | KY |