Provider Demographics
NPI:1669038105
Name:SMILE DOCTORS OF KENTUCKY PSC
Entity Type:Organization
Organization Name:SMILE DOCTORS OF KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEPPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-224-4294
Mailing Address - Street 1:295 SE INNER LOOP
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2140
Mailing Address - Country:US
Mailing Address - Phone:970-224-4294
Mailing Address - Fax:
Practice Address - Street 1:1481 CAVALRY LN STE 100
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8428
Practice Address - Country:US
Practice Address - Phone:859-282-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty