Provider Demographics
NPI:1598195737
Name:UNIVERSITY OF KENTUCKY
Entity Type:Organization
Organization Name:UNIVERSITY OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACULTY
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:646-645-4662
Mailing Address - Street 1:708 SUNNY SLOPE TRCE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1780
Mailing Address - Country:US
Mailing Address - Phone:646-645-4662
Mailing Address - Fax:
Practice Address - Street 1:708 SUNNY SLOPE TRCE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1780
Practice Address - Country:US
Practice Address - Phone:646-645-4667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9129302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization