Organization
PEDIATRIC DENTISTRY OF OLDHAM COUNTYQ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY LEANN KIM DMD,MBA (DENTISTR/OWNER)
(502) 222-8848
Entity
Organization
Contact information
Practice address
1000 BUCKNER CTR, SUITE 3, LA GRANGE, KY 40031-7790
(502) 222-8848
(502) 222-9319
Mailing address
1000 BUCKNER CTR, SUITE 3, LA GRANGE, KY 40031-7790
(502) 222-8848
(502) 222-9319
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7129
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538156849
PROVIDER NPI
—
Enumeration date
05/20/2013
Last updated
05/20/2013
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