Provider Demographics
NPI:1780187583
Name:MOUNT STERLING PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:MOUNT STERLING PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILEE
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-465-1641
Mailing Address - Street 1:2340 THISTLE PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8568
Mailing Address - Country:US
Mailing Address - Phone:606-465-1641
Mailing Address - Fax:
Practice Address - Street 1:25 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1267
Practice Address - Country:US
Practice Address - Phone:606-465-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9326122300000X
KY9631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty