Organization
DENTISTRY FOR CHILDREN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN GOBBLE (OFFICE MANAGER)
(859) 626-9620
Entity
Organization
Contact information
Practice address
1012 IVAL JAMES BLVD, SUITE C, RICHMOND, KY 40475-8174
(859) 626-9620
(859) 626-9622
Mailing address
1012 IVAL JAMES BLVD, SUITE C, RICHMOND, KY 40475-8174
(859) 626-9620
(859) 626-9622
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61901088
—
KY
Enumeration date
09/14/2006
Last updated
07/03/2013
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