Individual
DR. MARYLOU S HEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
3225 SUMMIT SQUARE PL, SUITE 150, LEXINGTON, KY 40509-2636
(859) 269-5386
(859) 266-6846
Mailing address
3225 SUMMIT SQUARE PL, SUITE 150, LEXINGTON, KY 40509-2636
(859) 269-5386
(859) 266-6846
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4853
KY
1223G0001X
General Practice Dentistry
Primary
4853
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45003753
—
KY
05
—
60048535
—
KY
Enumeration date
08/20/2006
Last updated
04/27/2011
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