Organization
MAYSVILLE PEDIATRIC DENTAL CENTER
Active
Other names
Maysville Pediatric Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE LUCAS DMD (OWNER/DENTIST)
(606) 934-8004
Entity
Organization
Contact information
Practice address
1415 KENTON POINTE WAY, MAYSVILLE, KY 41056-1174
(606) 934-8004
Mailing address
1415 KENTON POINTE WAY, MAYSVILLE, KY 41056-1174
(606) 934-8004
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821520024
—
KY
Enumeration date
05/06/2022
Last updated
05/06/2022
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