Kentuckiana Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

8111 Issued in KY

Legal business name

KENTUCKIANA PEDIATRIC DENTISTRY

Practice address

211 High Point CT Ste 500
Mt Washington, KY 40047-5559

Phone

(502) 538-2400

Fax

(502) 538-2403

NPI assigned

Mar 27, 2015

Organization subpart

No

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

Authorized official

Name

Jonathan Tyler Simms

Title

Practice Manager

Phone

(502) 538-2400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Eileen Schilling Haeberle, D.M.D.

  • Pediatric Dentistry
  • Mt Washington, KY
  • NPI 1659613479
  NPD (past)
• Matthew C Mitchell, DMD

  • Pediatric Dentistry
  • Mt Washington, KY
  • NPI 1871698043
  NPD (past)

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1851785877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 HIGH POINT CT STE 500",
            "city": "MT WASHINGTON",
            "state": "KY",
            "postal_code": "400475559",
            "telephone_number": "502-538-2400",
            "fax_number": "502-538-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 HIGH POINT CT STE 500",
            "city": "MT WASHINGTON",
            "state": "KY",
            "postal_code": "400475559",
            "telephone_number": "502-538-2400",
            "fax_number": "502-538-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKIANA PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-27",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "SIMMS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "502-538-2400"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "8111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100071020",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Geraci DMD PLLC
• Karen Anne Hughes
• Jarred Kelley, LPCC
• Monna Jean Kendrick, LPCC
• Crystal Kenney, LSW
• Kentuckiana Peds Dre LLC
• Kibbe Orthopedics PLLC
• Shane Jacob Kibbe, MD
• Carrie Kidwell, COTA/L
• Kiosk Medicine Kentucky LLC

• Pediatric Dentistry in Mt Washington, KY
• Providers in Mt Washington, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; 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.