Pediatric Dentistry of Southern Kentucky

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9156 Issued in KY

Legal business name

PEDIATRIC DENTISTRY OF SOUTHERN KENTUCKY

Practice address

234 Natchez Trace Ave
Bowling Green, KY 42103-7995

Phone

(270) 715-5437

Fax

(270) 715-0032

NPI assigned

Jul 20, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Shannon Pattee

Title

Billing Manager

Phone

(270) 715-5437

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SKY Pediatric Dentistry Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Gaynor Ashley, DMD, MSEDU, MS

  • Pediatric Dentistry
  • Bowling Green, KY
  • NPI 1124142773
  NPD (past)

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561507200000",
    "number": "1083067482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 NATCHEZ TRACE AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037995",
            "telephone_number": "270-715-5437",
            "fax_number": "270-715-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 NATCHEZ TRACE AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037995",
            "telephone_number": "270-715-5437",
            "fax_number": "270-715-0032"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Burley Ave",
            "address_purpose": "LOCATION",
            "city": "Hopkinsville",
            "state": "KY",
            "postal_code": "422408725",
            "country_code": "US",
            "telephone_number": "270-874-4971",
            "fax_number": "270-874-1063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF SOUTHERN KENTUCKY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2019-06-26",
        "status": "A",
        "authorized_official_last_name": "PATTEE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "270-715-5437",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "9156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100429210",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100232870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SKY Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SKY Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles Christopher Pearson, RPH
• Whitney Dawn Peay, LPCC, NCC
• Evelyn Anne Peck, PH.D.
• Lindsey Peden
• Pediatric Associates of Bowling Green, LLC
• Joshua A Pedigo, M.D.
• Lereasa Lynne Pedigo, CADC
• Brandie Pellett
• Brittany Pelly, BS
• Debra K Pendleton, LPN

• Pediatric Dentistry in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; 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.