Provider Demographics
NPI:1558564385
Name:FAMILY DYNAMICS LLC
Entity Type:Organization
Organization Name:FAMILY DYNAMICS LLC
Other - Org Name:COMPLETE FAMILY DENTISTRY AND DENTAL ASSOCIATES OF RICHMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-792-4236
Mailing Address - Street 1:1183 STANFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444
Mailing Address - Country:US
Mailing Address - Phone:859-792-4236
Mailing Address - Fax:859-792-6033
Practice Address - Street 1:1183 STANFORD RD.
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-9567
Practice Address - Country:US
Practice Address - Phone:859-792-4236
Practice Address - Fax:859-792-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4601261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental