Provider Demographics
NPI:1144394487
Name:CHALOTHORN, PADA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PADA
Middle Name:
Last Name:CHALOTHORN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 HARRODSBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2763
Mailing Address - Country:US
Mailing Address - Phone:859-223-8987
Mailing Address - Fax:859-224-4439
Practice Address - Street 1:3070 HARRODSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2763
Practice Address - Country:US
Practice Address - Phone:859-223-8987
Practice Address - Fax:859-224-4439
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice