Organization
CRISP DRE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH DAVIS (DIRECTOR OF REVENUE)
(859) 533-1109
Entity
Organization
Contact information
Practice address
11 CANARY LN, WINCHESTER, KY 40391-1645
(859) 744-7031
Mailing address
105 SPRUCE ST, LEXINGTON, KY 40507-2109
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/16/2023
Last updated
11/16/2023
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