Organization
PEDIATRIC DENTISTRY OF SOUTHERN KENTUCKY
Active
Other names
SKY Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON PATTEE (BILLING MANAGER)
(270) 715-5437
Entity
Organization
Contact information
Practice address
234 NATCHEZ TRACE AVE, BOWLING GREEN, KY 42103-7995
(270) 715-5437
(270) 715-0032
Mailing address
234 NATCHEZ TRACE AVE, BOWLING GREEN, KY 42103-7995
(270) 715-5437
(270) 715-0032
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9156
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100232870
—
KY
05
—
7100429210
—
KY
Enumeration date
07/20/2016
Last updated
06/26/2019
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