Provider Demographics
NPI:1407075088
Name:GENTLE CARE FAMILY COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:GENTLE CARE FAMILY COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FAHED
Authorized Official - Middle Name:
Authorized Official - Last Name:HISHMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-277-1151
Mailing Address - Street 1:2558 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3205
Mailing Address - Country:US
Mailing Address - Phone:859-277-1151
Mailing Address - Fax:
Practice Address - Street 1:2558 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3205
Practice Address - Country:US
Practice Address - Phone:859-277-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7403305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service