Provider Demographics
NPI:1134271919
Name:ARNOLD, KELLY A (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:ARNOLD
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 1:2393 ALUMNI DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4285
Mailing Address - Country:US
Mailing Address - Phone:859-268-8770
Mailing Address - Fax:859-268-8770
Practice Address - Street 1:2393 ALUMNI DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4285
Practice Address - Country:US
Practice Address - Phone:859-268-8770
Practice Address - Fax:859-268-8770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78901223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60001708Medicaid