Provider Demographics
NPI:1942667282
Name:GOLIBERSUCH, KYLE ASHLEY (DMD,)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ASHLEY
Last Name:GOLIBERSUCH
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 1:3141 BEAUMONT CENTRE CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1960
Mailing Address - Country:US
Mailing Address - Phone:859-223-2120
Mailing Address - Fax:859-223-5276
Practice Address - Street 1:3141 BEAUMONT CENTRE CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1960
Practice Address - Country:US
Practice Address - Phone:859-223-2120
Practice Address - Fax:859-223-5276
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9700OtherDENTAL PRACTICE