Provider Demographics
NPI:1881723559
Name:PATRICK M NUTINI PSC
Entity type:Organization
Organization Name:PATRICK M NUTINI PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NUTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:8593-311-7353
Mailing Address - Street 1:3005 DIXIE HWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-331-7353
Mailing Address - Fax:
Practice Address - Street 1:3005 DIXIE HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-7353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY4891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty