Provider Demographics
NPI:1184729873
Name:DENTISTRY FOR CHILDREN
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-626-9620
Mailing Address - Street 1:1012 IVAL JAMES BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8174
Mailing Address - Country:US
Mailing Address - Phone:859-626-9620
Mailing Address - Fax:859-626-9622
Practice Address - Street 1:1012 IVAL JAMES BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8174
Practice Address - Country:US
Practice Address - Phone:859-626-9620
Practice Address - Fax:859-626-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61901088Medicaid