Individual
DR. KELLY J CHRISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4384 CLEARWATER WAY STE 150, LEXINGTON, KY 40515
(859) 317-6810
Mailing address
4384 CLEARWATER WAY STE 150, 150, LEXINGTON, KY 40515
(859) 317-6810
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
8238
KY
1223G0001X
General Practice Dentistry
8238
KY
1223P0221X
Pediatric Dentistry
Primary
8238
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100006880
—
KY
Enumeration date
09/29/2006
Last updated
09/18/2024
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