Organization
INTERIM DENT PLLC
Active
Other names
Park Hills Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
JINYOUNG KIM DMD (OWNER)
(859) 273-5020
Entity
Organization
Contact information
Practice address
3122 CUSTER DR, LEXINGTON, KY 40517-4000
(859) 273-5020
(859) 245-2219
Mailing address
3122 CUSTER DR, LEXINGTON, KY 40517-4000
(859) 273-5020
(859) 245-2219
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100482030
—
KY
Enumeration date
07/22/2019
Last updated
01/18/2021
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