Provider Demographics
NPI:1841457363
Name:JOHN J DUPLESSIS, JR.
Entity type:Organization
Organization Name:JOHN J DUPLESSIS, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-765-6502
Mailing Address - Street 1:2401 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7941
Mailing Address - Country:US
Mailing Address - Phone:270-765-6502
Mailing Address - Fax:270-766-1988
Practice Address - Street 1:2401 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7941
Practice Address - Country:US
Practice Address - Phone:270-765-6502
Practice Address - Fax:270-766-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58951223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61942827Medicaid