Provider Demographics
NPI:1659910792
Name:ELIZABETHTOWN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:ELIZABETHTOWN PEDIATRIC DENTISTRY
Other - Org Name:PEDIATRIC DENTISTRY OF ELIZABETHTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEENASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:270-600-7337
Mailing Address - Street 1:103 FINANCIAL PL STE 101
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4470
Mailing Address - Country:US
Mailing Address - Phone:270-600-7337
Mailing Address - Fax:
Practice Address - Street 1:103 FINANCIAL PL STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4470
Practice Address - Country:US
Practice Address - Phone:270-600-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty