Provider Demographics
NPI:1245374172
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:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KORETSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-543-2242
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:
Practice Address - Street 1:216 FOUNTAIN CT
Practice Address - Street 2:SUITE#150
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1888
Practice Address - Country:US
Practice Address - Phone:859-543-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45000270001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4500027000Medicaid