Organization
DENTISTRY FOR CHILDREN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI A KORETSKI (OFFICE MANAGER)
(859) 543-2242
Entity
Organization
Contact information
Practice address
216 FOUNTAIN CT, SUITE#150, LEXINGTON, KY 40509-1888
(859) 543-2242
Mailing address
1012 IVAL JAMES BLVD, SUITE C, RICHMOND, KY 40475-8174
(859) 626-9620
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4500027000
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4500027000
—
KY
Enumeration date
02/16/2007
Last updated
08/22/2020
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