Provider Demographics
NPI:1770680761
Name:FAMILY DENTAL CARE OF KENTUCKY PSC
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE SHAREHOLDER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:BENANTI
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-254-8745
Mailing Address - Street 1:802 KINROSS PLACE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243
Mailing Address - Country:US
Mailing Address - Phone:502-254-8745
Mailing Address - Fax:502-254-8874
Practice Address - Street 1:502 MOUNT EDEN ROAD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065
Practice Address - Country:US
Practice Address - Phone:502-633-1538
Practice Address - Fax:502-633-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty