Individual
DR. POLLY BLAKE BUCKEY BOEHNLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1301 WINCHESTER RD STE 225, LEXINGTON, KY 40505-4132
(859) 258-2552
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7932
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60001989
—
KY
Enumeration date
08/23/2006
Last updated
04/27/2012
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