Provider Demographics
NPI:1851830723
Name:KY DENTAL PROFESSIONALS II PSC
Entity Type:Organization
Organization Name:KY DENTAL PROFESSIONALS II PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANALYST, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-241-1931
Mailing Address - Street 1:PO BOX 306208
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6208
Mailing Address - Country:US
Mailing Address - Phone:615-620-5990
Mailing Address - Fax:888-702-3012
Practice Address - Street 1:1836 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-2708
Practice Address - Country:US
Practice Address - Phone:270-442-0256
Practice Address - Fax:270-442-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty