Provider Demographics
NPI:1023496676
Name:KIDS DENTISTREE - SHEPHERDSVILLE, PLLC
Entity type:Organization
Organization Name:KIDS DENTISTREE - SHEPHERDSVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8500
Mailing Address - Street 1:1779 HIGHWAY 44 E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6132
Mailing Address - Country:US
Mailing Address - Phone:502-281-4860
Mailing Address - Fax:502-883-6995
Practice Address - Street 1:1779 HIGHWAY 44 E
Practice Address - Street 2:SUITE 200
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6132
Practice Address - Country:US
Practice Address - Phone:502-281-4860
Practice Address - Fax:502-883-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty