Organization
KENTUCKY TONGUE-TIE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN RODENBERG DMD, MSD (OWNER)
(270) 572-9309
Entity
Organization
Contact information
Practice address
6400 WESTWIND WAY STE C, CRESTWOOD, KY 40014-6773
(502) 754-1607
(859) 207-5102
Mailing address
934 WOODLAND RIDGE CIR, LA GRANGE, KY 40031-1373
(502) 754-6633
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
03/25/2024
Last updated
03/18/2025
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