Modern Kids Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

8732 Issued in KY

Legal business name

MODERN KIDS DENTISTRY

Practice address

4384 Clearwater Way
Suite 150
Lexington, KY 40515-6477

Phone

(859) 321-7051

NPI assigned

Jan 13, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Justin Michael Raybould, D.M.D.NPI 1689817579

Title

President/Ceo

Phone

(859) 321-7051

Specialties & licenses 1

Addresses

Tax ID family

Lexington Children'S Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lexington Children'S Dentistry

  • Pediatric Dentistry
  • Lexington, KY
  • NPI 1194115857
  NPD tax ID

Practitioners 1

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

• Justin Michael Raybould, D.M.D.

  • Pediatric Dentistry
  • Lexington, KY
  • NPI 1689817579
  NPD (past) Authorized official

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428883200000",
    "number": "1174912224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 BEECHMONT RD",
            "address_2": "SUITE 150",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405022837",
            "telephone_number": "859-321-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4384 CLEARWATER WAY",
            "address_2": "SUITE 150",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405156477",
            "telephone_number": "859-321-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN KIDS DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-04-13",
        "status": "A",
        "authorized_official_last_name": "RAYBOULD",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "859-321-7051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "8732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Scott Moberley, DPT
• Heather Nicole Moberly, DNP, APRN
• Maura Mobilia
• Mobility Access Providers, Inc
• Modern Dermatology of Kentucky LLC
• Wendy Modjeski, ST
• Bhavini Bharat Mody, APRN
• Krista Moe, PHD
• Carol D. Moffett, ATP
• Erika Jay Moffitt, APRN

• Pediatric Dentistry in Lexington, KY
• Providers in Lexington, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; 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.