Organization
DENTISTRY FOR CHILDREN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN GOBBLE (OFFICE MANAGER)
(502) 868-9300
Entity
Organization
Contact information
Practice address
205 CHAMPION WAY, SUITE 9, GEORGETOWN, KY 40324-8862
(502) 868-9300
Mailing address
216 FOUNTAIN CT, SUITE#150, LEXINGTON, KY 40509-1888
(859) 543-2242
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100169540
—
KY
Enumeration date
08/23/2007
Last updated
07/03/2013
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