NPIMap

Organization Active NPI

Maysville Pediatric Dental Center

  • Dental Clinic/Center
  • Maysville, KY
National Provider Identifier
1750027413
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MAYSVILLE PEDIATRIC DENTAL CENTER
Practice address
1415 Kenton Pointe Way
Maysville, KY 41056-1174
Phone
(606) 934-8004
NPI assigned
May 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Authorized official

Name
Mackenzie Lucas, DMDNPI 1821520024
Title
Owner/Dentist
Phone
(606) 934-8004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1415 Kenton Pointe Way
Maysville, KY 41056-1174

Mailing address

1415 Kenton Pointe Way
Maysville, KY 41056-1174
Phone (606) 934-8004

Other identifiers 1

IdentifierTypeStateIssuer
1821520024MedicaidKY

Other names 1

  • Maysville Pediatric Dental Center Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Maysville Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

1415 Kenton Pointe Way
Maysville, KY 41056
Phone (606) 934-8004

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1750027413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 KENTON POINTE WAY",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410561174",
            "telephone_number": "606-934-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 KENTON POINTE WAY",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410561174",
            "telephone_number": "606-934-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYSVILLE PEDIATRIC DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-06",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "606-934-8004",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821520024",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Maysville",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1415 Kenton Pointe Way",
            "city": "Maysville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "410561174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Maysville Pediatric Dental Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Maysville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.