Organization
PEDIATRIC DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC M SOPER DMD (OWNER)
(859) 534-5640
Entity
Organization
Contact information
Practice address
5495 N BEND RD, SUITE 102, BURLINGTON, KY 41005-9378
(859) 534-5640
(859) 534-5922
Mailing address
5495 N BEND RD, SUITE 102, BURLINGTON, KY 41005-9378
(859) 534-5640
(859) 534-5922
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
736
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60002821
—
KY
Enumeration date
11/15/2011
Last updated
11/15/2011
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