Provider Demographics
NPI:1164200580
Name:OP ORTHODONTICS OF KENTUCKY PLLC
Entity Type:Organization
Organization Name:OP ORTHODONTICS OF KENTUCKY PLLC
Other - Org Name:DROBOCKY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-283-8867
Mailing Address - Street 1:5300 PATTERSON AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9758
Mailing Address - Country:US
Mailing Address - Phone:616-283-8867
Mailing Address - Fax:
Practice Address - Street 1:727 U.S. 31-W BYPASS
Practice Address - Street 2:SUITE 113
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-843-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OP ORTHODONTICS OF KENTUCKY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty