# BOURBON FAMILY DENTISTRY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1396801395
- **Authorized official:** DR. MARION SUSANNE KOLLAHSADEH DMD (DENTIST OWNER)
- **Authorized official phone:** (859) 988-0308

## Contact information

- **Practice address:** 4223 A LEXINGTON RD, PARIS, KY 40361
- **Practice address phone:** (859) 988-0308
- **Practice address fax:** (859) 988-0310
- **Mailing address:** 4223 A LEXINGTON RD, PARIS, KY 40361
- **Mailing address phone:** (859) 988-0308
- **Mailing address fax:** (859) 988-0310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7770KY | KY | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 08/22/2020