Provider Demographics
NPI:1972606051
Name:KENTUCKY CENTER FOR ORTHODONTICS, PSC
Entity Type:Organization
Organization Name:KENTUCKY CENTER FOR ORTHODONTICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/SEC/TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-223-3939
Mailing Address - Street 1:860 CORPORATE DR
Mailing Address - Street 2:STE. 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 CORPORATE DR
Practice Address - Street 2:STE. 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5425
Practice Address - Country:US
Practice Address - Phone:859-223-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60052388Medicaid