Provider Demographics
NPI:1255585758
Name:DENTAL SERVICES OF KENTUCKY, PSC
Entity type:Organization
Organization Name:DENTAL SERVICES OF KENTUCKY, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-800-6952
Mailing Address - Street 1:PO BOX 11568
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4268
Mailing Address - Country:US
Mailing Address - Phone:913-428-1674
Mailing Address - Fax:866-591-0604
Practice Address - Street 1:4960 HOUSTON RD
Practice Address - Street 2:STE G
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5132
Practice Address - Country:US
Practice Address - Phone:859-371-1505
Practice Address - Fax:866-591-0604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL SERVICES OF KENTUCKY, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty