Organization Name: | KIDS DENTISTRY-LAGRANGE, PLLC |
NPI Number: | 1104196989 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SETPHEN JAMES (CFO) |
Mailing Address: | 2005 S Highway 53 Suite D La Grange |
State: | KY US |
Postal Code: | 400319109 |
Phone Number: | 5022256820 |
Fax Number: | |
NPI Enumeration Date: | 01/10/2012 |
NPI Last Update Date: | 01/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |