Organization
KENTUCKY RIVER DENTISTRY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE JORDAN D.M.D. (DENTIST)
(606) 723-4112
Entity
Organization
Contact information
Practice address
161 RICHMOND RD, IRVINE, KY 40336-7222
(606) 723-4112
(606) 723-5372
Mailing address
161 RICHMOND RD, IRVINE, KY 40336-7222
(606) 723-4112
(606) 723-5372
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6144
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61900221
—
KY
Enumeration date
02/15/2007
Last updated
09/23/2013
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