Organization
LEXINGTON PERIODONTICS AND IMPLANT DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANCY K VON LACKUM DMD, PHD (PERIODONTIST)
(859) 269-0070
Entity
Organization
Contact information
Practice address
620 PERIMETER DR STE 201, LEXINGTON, KY 40517-4125
(859) 269-0070
(859) 367-0079
Mailing address
620 PERIMETER DR STE 201, LEXINGTON, KY 40517-4125
(859) 269-0070
(859) 367-0079
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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