Provider Demographics
NPI:1982866273
Name:KENTUCKY HEAD AND NECK IMAGING
Entity Type:Organization
Organization Name:KENTUCKY HEAD AND NECK IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-543-0700
Mailing Address - Street 1:3285 BLAZER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2119
Mailing Address - Country:US
Mailing Address - Phone:859-543-0700
Mailing Address - Fax:859-543-1078
Practice Address - Street 1:3285 BLAZER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2119
Practice Address - Country:US
Practice Address - Phone:859-543-0700
Practice Address - Fax:859-543-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty