Provider Demographics
NPI:1396946752
Name:PATRICIA E TAKACS DMD PSC
Entity type:Organization
Organization Name:PATRICIA E TAKACS DMD PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAKACS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-223-2120
Mailing Address - Street 1:3141 BEAUMONT CENTRE CIRCLE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1934
Mailing Address - Country:US
Mailing Address - Phone:859-223-2120
Mailing Address - Fax:859-223-1695
Practice Address - Street 1:3141 BEAUMONT CENTRE CIRCLE
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1934
Practice Address - Country:US
Practice Address - Phone:859-223-2120
Practice Address - Fax:859-223-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5595122300000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty