MFDC of Ky LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MFDC OF KY LLC

Doing business as

Mortenson Family Dental Center - Dry RIdge

Practice address

99 S Main St
Dry Ridge, KY 41035-7343

Phone

(859) 785-5717

NPI assigned

Feb 17, 2021

Last updated

May 28, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

MORTENSON FAMILY DENTAL CENTERAs reported in NPPES

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

Authorized official

Name

Jeff Reibel

Title

Cfo

Phone

(502) 254-8500

Specialties & licenses 1

Addresses

Other names 1

• Mortenson Family Dental Center - Dry RIdge Doing business as

Part of

MFDC of Ky LLC

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.

• Calley Jo Perry, DMD

  • Dentist
  • Dry Ridge, KY
  • NPI 1639192289
  NPD

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

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1437742855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437169",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402537169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 S MAIN ST",
            "city": "DRY RIDGE",
            "state": "KY",
            "postal_code": "410357343",
            "telephone_number": "859-785-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MFDC OF KY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MORTENSON FAMILY DENTAL CENTER",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "REIBEL",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "502-254-8500"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mortenson Family Dental Center - Dry RIdge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mortenson Family Dental Center - Dry RIdge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Lowe, LDO
• Zoe Luebbe, DPT
• Nicholas Ryan Mairose, LDO
• Timothy J McMahon, DMD
• Brian Melton, APRN
• Hunter Mitchell, DMD
• Amanda Lerae Naranjo, PHARMD
• Anna M Newton, RBT
• Suzanne Renee Noel, M.S., OTR/L
• Elyse Pennington, PHARMD

• Dentist in Dry Ridge, KY
• Providers in Dry Ridge, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.