Organization
KIDS DENTISTREE OF KY, LLC
Active
Other names
Kids Dentistree - Breckenridge
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN JAMES (CFO)
(502) 254-8500
Entity
Organization
Contact information
Practice address
3101 BRECKENRIDGE LN STE 4B, LOUISVILLE, KY 40220-2797
(502) 451-1020
(502) 451-9339
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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