Organization
PEDIATRIC DENTISTRY OF SHELBYVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY E RAISOR (OFFICE MANAGER)
(502) 633-4441
Entity
Organization
Contact information
Practice address
141 STONECREST RD, SHELBYVILLE, KY 40065-8164
(502) 633-4441
(502) 633-4470
Mailing address
141 STONECREST RD, SHELBYVILLE, KY 40065-8164
(502) 633-4441
(502) 633-4470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7277
KY
1223P0221X
Pediatric Dentistry
Primary
7601
KY
Other
Enumeration date
07/21/2008
Last updated
10/08/2009
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