Provider Demographics
NPI:1679620504
Name:DERER, CINDY MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:MICHELLE
Last Name:DERER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 PERIMETER DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4141
Mailing Address - Country:US
Mailing Address - Phone:859-268-9090
Mailing Address - Fax:859-266-2410
Practice Address - Street 1:698 PERIMETER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4141
Practice Address - Country:US
Practice Address - Phone:859-268-9090
Practice Address - Fax:859-266-2410
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice