Provider Demographics
NPI:1043090673
Name:KELLY MOORE MEADOR, DMD PLLC
Entity type:Organization
Organization Name:KELLY MOORE MEADOR, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUZANN
Authorized Official - Last Name:MOORE MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-322-4060
Mailing Address - Street 1:5150 TAYLOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-2158
Mailing Address - Country:US
Mailing Address - Phone:859-491-3411
Mailing Address - Fax:859-491-3417
Practice Address - Street 1:5150 TAYLOR MILL RD
Practice Address - Street 2:
Practice Address - City:TAYLOR MILL
Practice Address - State:KY
Practice Address - Zip Code:41015-2158
Practice Address - Country:US
Practice Address - Phone:859-491-3411
Practice Address - Fax:859-491-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental