Organization
MOREHEAD PEDIATRIC DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT DOUGLAS KIDD D.M.D. (OWNER/OPERATOR)
(606) 776-9863
Entity
Organization
Contact information
Practice address
1275 HALLWOOD DRIVE, MOREHEAD, KY 40351
(606) 776-9863
Mailing address
6927 WOODHAVEN PLACE DR, LOUISVILLE, KY 40228-2804
(606) 776-9863
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9075
KY
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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