NPIMap

Organization Active NPI

Dental Services of Kentucky, PSC

Doing business as ImmediaDent

  • Dentist
  • Lexington, KY
National Provider Identifier
1821248162
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL SERVICES OF KENTUCKY, PSC
Doing business as
ImmediaDent
Practice address
2358 Nicholasville Rd
#156
Lexington, KY 40503-3032
Phone
(859) 381-0680
Fax
(859) 381-0633
NPI assigned
Sep 23, 2008
Last updated
Apr 12, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL SERVICES OF KENTUCKY, PSCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Authorized official

Name
Amy Wheeler
Title
Credentialing Coordinator
Phone
(913) 800-6952

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

2358 Nicholasville Rd
#156
Lexington, KY 40503-3032

Mailing address

PO Box 11568
Ste 155
Overland, KS 66207-4268
Phone (913) 428-1674

Other identifiers 1

IdentifierTypeStateIssuer
7100058850MedicaidKY

Other names 1

  • ImmediaDent Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Services of Louisville PSC10 organizations share this tax ID, including this one
Part of
Dental Services of Louisville PSC

Other organizations with this tax ID 9

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

Locations

2358 Nicholasville Rd
Ste 156
Lexington, KY 40503
Phone (859) 381-0680

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1821248162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11568",
            "address_2": "STE 155",
            "city": "OVERLAND",
            "state": "KS",
            "postal_code": "662074268",
            "telephone_number": "913-428-1674",
            "fax_number": "866-591-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2358 NICHOLASVILLE RD",
            "address_2": "#156",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033032",
            "telephone_number": "859-381-0680",
            "fax_number": "859-381-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SERVICES OF KENTUCKY, PSC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL SERVICES OF KENTUCKY, PSC",
        "enumeration_date": "2008-09-23",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "913-800-6952"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100058850",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ImmediaDent",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.