Organization
EARLY YEARS ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY SUTPHIN (OFFICE MANAGER)
(502) 227-1931
Entity
Organization
Contact information
Practice address
635 COMANCHE TRL, FRANKFORT, KY 40601-1753
(502) 227-1931
Mailing address
635 COMANCHE TRL, FRANKFORT, KY 40601-1753
(502) 227-1931
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
522
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598865180
TYPE 1 NPI
KY
Enumeration date
11/30/2011
Last updated
11/30/2011
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