Nita Suzann Isgrigg, DMD
Individual provider
Active NPI
Dentist · Mt Washington, KY
NPI 1154413342 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154413342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7359 (KY)
- Practice address
- 110 Village LN
Mt Washington, KY 40047-7658
- Phone
- (502) 538-3434
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20180424002973 |
KY |
Order and Referring Only - Dentist
Practitioner - Dentist |
0042573123 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 7359 | KY | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
7359 |
KY |
Yes |
Addresses
Primary practice location
110 Village LN
Mt Washington, KY 40047-7658
Mailing address
110 Village LN
Mt Washington, KY 40047-7658
Phone (502) 538-3434
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 60073590 | Medicaid | KY | |