Organization
BROADWAY FAMILY AND COSMETIC DENTISTRY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. APRILLE RASHEDA NELSON DMD (OWNER)
(859) 253-3242
Entity
Organization
Contact information
Practice address
556 N BROADWAY, LEXINGTON, KY 40508-1761
(859) 253-3242
(859) 253-0025
Mailing address
556 N BROADWAY, LEXINGTON, KY 40508-1761
(859) 253-3242
(859) 253-0025
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8731
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100149080
—
KY
Enumeration date
04/21/2011
Last updated
04/21/2011
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