# DENTRUST KENTUCKY, PSC

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

## Provider details

- **NPI number:** 1861043499
- **Authorized official:** AMANDA CLARK (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (813) 451-4503

## Contact information

- **Practice address:** 2840 BASTOGNE AVE, FORT CAMPBELL, KY 42223-5114
- **Practice address phone:** (267) 927-5000
- **Mailing address:** 6097 EASTON RD, PIPERSVILLE, PA 18947-1810

## Taxonomy

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

## Other

- **Enumeration date:** 09/25/2019
- **Last updated:** 02/08/2023