Organization
DANVILLE PEDIATRIC DENTISTRY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY T JOHNSON D.M.D.M.PH. (OWNER)
(859) 236-6900
Entity
Organization
Contact information
Practice address
1080 BEN ALI DR, SUITE A, DANVILLE, KY 40422-8937
(859) 236-6900
(859) 236-6997
Mailing address
1080 BEN ALI DR, SUITE A, DANVILLE, KY 40422-8937
(859) 236-6900
(859) 236-6997
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7737
KY
1223P0221X
Pediatric Dentistry
7737
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223G0001X
EPSDT
KY
05
—
1223P0221X
—
KY
Enumeration date
04/18/2011
Last updated
10/25/2016
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