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Organization
DENTAL WELLNESS OF LEXINGTON
Active
Organization
DENTAL WELLNESS OF LEXINGTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MANDY WALLIN (OFFICE MANAGER)
(859) 223-4644
Entity
Organization
Contact information
Practice address
527 WELLINGTON WAY, SUITE 120, LEXINGTON, KY 40503
(859) 223-4644
(859) 224-8466
Mailing address
527 WELLINGTON WAY, SUITE 120, LEXINGTON, KY 40503
(859) 223-4644
(859) 224-8466
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
55800
KY
122300000X
Dentist
8009
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000806082
UNITED CONCORDIA
—
01
—
333276
BCBS OF KY FEDERAL
—
Enumeration date
08/15/2006
Last updated
05/09/2018
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