Dentrust Kentucky, PSC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DENTRUST KENTUCKY, PSC

Practice address

2840 Bastogne Ave
Fort Campbell, KY 42223-5114

Phone

(267) 927-5000

NPI assigned

Sep 25, 2019

Organization subpart

No

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

Authorized official

Name

Amanda Clark

Title

Director of Credentialing

Phone

(813) 451-4503

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1861043499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6097 EASTON RD",
            "city": "PIPERSVILLE",
            "state": "PA",
            "postal_code": "189471810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 BASTOGNE AVE",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235114",
            "telephone_number": "267-927-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTRUST KENTUCKY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-25",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "813-451-4503"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felix E. Dejesus, LCSW
• Amanda Jo Del Giorno, OTD, OTR/L
• Jason B Deleeuw
• Austin George Demaagd, MD
• Andrew Joseph Denison, M.D.
• Department of Defense
• Alexander Despois
• Whitney A Devers
• Mario Di Biase, PSY.D.
• Ramon Diaz, M.D.

• Dentist in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.