Organization
KDG KENTUCKY 4
Active
Parent organization
KENTUCKIANA DENTAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENTUCKIANA DENTAL GROUP
Authorized official
ADIRNNE NICHOLSON (OFFICE MANAGER)
(812) 523-1860
Entity
Organization
Contact information
Practice address
105 EMINENCE TER, EMINENCE, KY 40019-1145
(812) 523-1860
Mailing address
105 EMINENCE TER, EMINENCE, KY 40019-1145
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/23/2018
Last updated
05/23/2018
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