Organization
ERENA & PETERSON, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON L. HINTON (PRACTICE ADMINISTRATOR)
(859) 268-4423
Entity
Organization
Contact information
Practice address
620 PERIMETER DR, SUITE 100, LEXINGTON, KY 40517-4125
(859) 268-4423
(859) 268-0010
Mailing address
620 PERIMETER DR, SUITE 100, LEXINGTON, KY 40517-4125
(859) 268-4423
(859) 268-0010
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100150110
MEDICAID DENTAL
KY
01
—
7100158900
MEDICAID MEDICAL
KY
01
—
P100036989
MEDICARE PTAN
—
Enumeration date
09/20/2010
Last updated
07/06/2011
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