Individual
RODRIGO FUENTEALBA HIDALGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
800 ROSE ST RM D642, UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY, LEXINGTON, KY 40536-0297
(859) 323-5831
Mailing address
800 ROSE ST RM D642, UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY, LEXINGTON, KY 40536-0297
(859) 323-5831
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9131
KY
1223G0001X
General Practice Dentistry
9131
KY
1223P0700X
Prosthodontics
Primary
9131
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100196940
—
KY
Enumeration date
10/16/2011
Last updated
01/20/2015
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