NPIMap

Organization Active NPI

Pediatric Dentistry of Oldham Countyq

  • Dentist
  • La Grange, KY
National Provider Identifier
1033555982
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7129 Issued in KY
Legal business name
PEDIATRIC DENTISTRY OF OLDHAM COUNTYQ
Practice address
1000 Buckner Ctr
Suite 3
La Grange, KY 40031-7790
Phone
(502) 222-8848
Fax
(502) 222-9319
NPI assigned
May 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tracy Leann Kim, DMD,MBANPI 1538156849
Title
Dentistr/Owner
Phone
(502) 222-8848

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7129 KY Primary

Addresses

Primary practice location

1000 Buckner Ctr
Suite 3
La Grange, KY 40031-7790

Mailing address

1000 Buckner Ctr
Suite 3
La Grange, KY 40031-7790
Phone (502) 222-8848

Other identifiers 1

IdentifierTypeStateIssuer
1538156849OtherPROVIDER NPI

National Provider Directory

National Provider Directory

Locations

1000 Buckner Ctr
Ste 3
La Grange, KY 40031
Phone (502) 222-8848

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1033555982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BUCKNER CTR",
            "address_2": "SUITE 3",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400317790",
            "telephone_number": "502-222-8848",
            "fax_number": "502-222-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BUCKNER CTR",
            "address_2": "SUITE 3",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400317790",
            "telephone_number": "502-222-8848",
            "fax_number": "502-222-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF OLDHAM COUNTYQ",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-20",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LEANN",
        "authorized_official_title_or_position": "DENTISTR/OWNER",
        "authorized_official_telephone_number": "502-222-8848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD,MBA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "KY",
            "license": "7129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1538156849",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.