Pdos Dre LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PDOS DRE LLC

Practice address

141 Stonecrest Rd Ste 1
Shelbyville, KY 40065-8165

Phone

(502) 633-4441

NPI assigned

Nov 6, 2023

Organization subpart

No

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

Authorized official

Name

Elizabeth Davis

Title

Director of Revenue

Phone

(859) 533-1109

Specialties & licenses 1

Addresses

Practitioners 2

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

• Kirby Chambers Hoetker, DMD

  • Pediatric Dentistry
  • Shelbyville, KY
  • NPI 1598767030
  NPD (past)
• Katrina Nicole Raneses, DMD

  • Dentist
  • Elizabethtown, KY
  • NPI 1437032000
  NPD (past)

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

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699228800000",
    "number": "1659144285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SPRUCE ST",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405072109",
            "telephone_number": "859-533-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 STONECREST RD STE 1",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400658165",
            "telephone_number": "502-633-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDOS DRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE",
        "authorized_official_telephone_number": "859-533-1109"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Parsley
• Caleb Pate, LCSW, LCADC
• Courtney Patrick, OT
• Cindy S Payne, LPN
• Donald W Payne, MD
• Pediatric and Neonatal Practice
• Pediatric Dentistry of Shelbyville
• Pediatric Products, LLC
• Pediatric Products, LLC
• Penny Pendleton

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.