NPIMap

Organization Active NPI

Dental Professional of Kentucky PSC

Doing business as Blossom Park Dental Care

  • Dentist
  • Georgetown, KY
National Provider Identifier
1912060351
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL PROFESSIONAL OF KENTUCKY PSC
Doing business as
Blossom Park Dental Care
Practice address
240 Blossom Park Dr
Suite 2
Georgetown, KY 40324-9079
Phone
(502) 570-8841
Fax
(502) 570-8891
NPI assigned
Dec 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Amy M Kroeger
Title
Insurance Cood
Phone
(218) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

240 Blossom Park Dr
Suite 2
Georgetown, KY 40324-9079

Mailing address

240 Blossom Park Dr
Suite 2
Georgetown, KY 40324-9079
Phone (502) 570-8841

Other names 1

  • Blossom Park Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Blossom Park Dental Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

240 Blossom Park Dr
Ste 2
Georgetown, KY 40324
Phone (502) 570-8841

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": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912060351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 BLOSSOM PARK DR",
            "address_2": "SUITE 2",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249079",
            "telephone_number": "502-570-8841",
            "fax_number": "502-570-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 BLOSSOM PARK DR",
            "address_2": "SUITE 2",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249079",
            "telephone_number": "502-570-8841",
            "fax_number": "502-570-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONAL OF KENTUCKY PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KROEGER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "INSURANCE COOD",
        "authorized_official_telephone_number": "218-540-5100"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossom Park Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.