Provider Demographics
NPI:1346992179
Name:KELSEY DUFF PLLC
Entity Type:Organization
Organization Name:KELSEY DUFF PLLC
Other - Org Name:BRUSH KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:BARBATO
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-600-4360
Mailing Address - Street 1:2092 FALLON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3008
Mailing Address - Country:US
Mailing Address - Phone:859-516-1153
Mailing Address - Fax:
Practice Address - Street 1:1005 PARKVIEW CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1579
Practice Address - Country:US
Practice Address - Phone:502-600-4360
Practice Address - Fax:502-600-4390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELSEY DUFF PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100560010Medicaid