Provider Demographics
NPI:1407744089
Name:DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C.
Entity type:Organization
Organization Name:DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:450 RICHWOOD RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-7440
Mailing Address - Country:US
Mailing Address - Phone:859-419-0768
Mailing Address - Fax:
Practice Address - Street 1:450 RICHWOOD RD STE 305
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-7440
Practice Address - Country:US
Practice Address - Phone:859-419-0768
Practice Address - Fax:859-419-0769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty