Provider Demographics
NPI:1245669449
Name:NORTHERN KENTUCKY DENTAL CENTERS-BUTTERMILK,PLLC
Entity type:Organization
Organization Name:NORTHERN KENTUCKY DENTAL CENTERS-BUTTERMILK,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SASDRINIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-801-4036
Mailing Address - Street 1:2446 ANDERSON RD
Mailing Address - Street 2:SUIT ONE
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1400
Mailing Address - Country:US
Mailing Address - Phone:859-331-8200
Mailing Address - Fax:
Practice Address - Street 1:2446 ANDERSON RD
Practice Address - Street 2:SUIT ONE
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1400
Practice Address - Country:US
Practice Address - Phone:859-331-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty