Modern Kids Dentistry of Elizabethtown, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MODERN KIDS DENTISTRY OF ELIZABETHTOWN, PLLC

Practice address

151 Drexler Cir # a
Elizabethtown, KY 42701-7843

Phone

(859) 608-1579

NPI assigned

May 7, 2019

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, DMDNPI 1689817579

Title

Owner/Manager

Phone

(859) 321-7051

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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 Authorized official

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1285299149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23293",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405233293",
            "telephone_number": "859-321-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 DREXLER CIR # A",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017843",
            "telephone_number": "859-608-1579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN KIDS DENTISTRY OF ELIZABETHTOWN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "RAYBOULD",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "859-321-7051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100342680",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krista Mitchell
• Lee Mitchell, APRN
• Mobility Plus Homecare, Inc.
• Caitlin E. Mobley
• Rachel Ann Mobley
• Mohammad J. Iqbal
• Mohammad K Gayasaddin
• Mohammed a. Siddiqui, M.D., PLLC
• Dwayne Edward Mollison Sr., M.ED, LPCA
• Kayleigh Rose Money, FNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.