Provider Demographics
NPI:1740441013
Name:WELLINGTON FAMILY DENTISTRY, PSC
Entity type:Organization
Organization Name:WELLINGTON FAMILY DENTISTRY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:RAMSDALE
Authorized Official - Last Name:JOHANNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-309-9765
Mailing Address - Street 1:535 WELLINGTON WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1387
Mailing Address - Country:US
Mailing Address - Phone:859-309-9765
Mailing Address - Fax:
Practice Address - Street 1:535 WELLINGTON WAY STE 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1385
Practice Address - Country:US
Practice Address - Phone:859-552-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty