Provider Demographics
NPI:1073883955
Name:WENDY K. HUMPHREY, DMD, PLLC
Entity Type:Organization
Organization Name:WENDY K. HUMPHREY, DMD, PLLC
Other - Org Name:KENTUCKY DENTISTRY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:HUMPHREY
Authorized Official - Last Name:VAN METER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-277-5437
Mailing Address - Street 1:181 W LOWRY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3016
Mailing Address - Country:US
Mailing Address - Phone:859-277-5437
Mailing Address - Fax:859-277-8827
Practice Address - Street 1:181 W LOWRY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3016
Practice Address - Country:US
Practice Address - Phone:859-277-5437
Practice Address - Fax:859-277-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002839Medicaid