Organization
BLUEGRASS FAMILY DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELSEY DIANE JOHNSON D.M.D. (OWNER/MEMBER)
(270) 256-3967
Entity
Organization
Contact information
Practice address
1317 N MAIN ST, BEAVER DAM, KY 42320-8957
(270) 775-6063
(270) 775-6123
Mailing address
PO BOX 535, BEAVER DAM, KY 42320-0535
(270) 775-6063
(270) 775-6123
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9595
KY
Other
Enumeration date
05/02/2017
Last updated
05/02/2017
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