# DENTAL PROFESSIONAL OF KENTUCKY PSC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blossom Park Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912060351
- **Authorized official:** AMY M KROEGER (INSURANCE COOD)
- **Authorized official phone:** (218) 540-5100

## Contact information

- **Practice address:** 240 BLOSSOM PARK DR, SUITE 2, GEORGETOWN, KY 40324-9079
- **Practice address phone:** (502) 570-8841
- **Practice address fax:** (502) 570-8891
- **Mailing address:** 240 BLOSSOM PARK DR, SUITE 2, GEORGETOWN, KY 40324-9079
- **Mailing address phone:** (502) 570-8841
- **Mailing address fax:** (502) 570-8891

## Taxonomy

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

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 08/22/2020