Provider Demographics
NPI:1982768974
Name:DENTAL CARE OF KENTUCKY, P.S.C.
Entity type:Organization
Organization Name:DENTAL CARE OF KENTUCKY, P.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:4097 NICHOLS PARK DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4428
Mailing Address - Country:US
Mailing Address - Phone:859-971-9238
Mailing Address - Fax:859-971-9274
Practice Address - Street 1:4097 NICHOLS PARK DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4428
Practice Address - Country:US
Practice Address - Phone:859-971-9238
Practice Address - Fax:859-971-9274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL CARE OF KENTUCKY, P.S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty