Provider Demographics
NPI:1184722142
Name:WIMSATT, JOAN ROBERTS (DMD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ROBERTS
Last Name:WIMSATT
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 1:810 CHEVY CHASE PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2144
Mailing Address - Country:US
Mailing Address - Phone:859-266-1181
Mailing Address - Fax:
Practice Address - Street 1:810 CHEVY CHASE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2144
Practice Address - Country:US
Practice Address - Phone:859-266-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice