Organization
PEDIATRIC DENTISTRY OF HAMBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODNEY ALLEN JACKSON D.M.D. (PEDODONTIST)
(859) 543-2456
Entity
Organization
Contact information
Practice address
2517 SIR BARTON WAY, SUITE #200, LEXINGTON, KY 40509-2275
(859) 543-2456
(859) 543-2373
Mailing address
2517 SIR BARTON WAY, SUITE #200, LEXINGTON, KY 40509-2275
(859) 543-2456
(859) 543-2373
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60002201
—
KY
05
—
60004041
—
KY
Enumeration date
05/16/2007
Last updated
08/22/2020
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