Provider Demographics
NPI:1750846234
Name:SMART DENTAL & HYGIENE EXPRESS
Entity Type:Organization
Organization Name:SMART DENTAL & HYGIENE EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-309-1356
Mailing Address - Street 1:2600 NICHOLASVILLE ROAD SUITE 120
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 NICHOLASVILLE RD SUITE 120
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-309-1356
Practice Address - Fax:859-309-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty