| Modern Kids Dentistry Of Nicholasville | |
|
611 N Main St Nicholasville KY 40356-1025 | |
| (859) 759-4428 | |
| Not Available |
| Full Name | Modern Kids Dentistry Of Nicholasville |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 611 N Main St, Nicholasville, Kentucky |
| Authorized Official Name and Position | Justin Michael Raybould (MANAGER) |
| Authorized Official Contact | 8593217051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Kids Dentistry Of Nicholasville 611 N Main St Nicholasville KY 40356-1025 Ph: (859) 759-4428 | Modern Kids Dentistry Of Nicholasville 611 N Main St Nicholasville KY 40356-1025 Ph: (859) 759-4428 |
| NPI Number | 1851821854 |
|---|---|
| Provider Enumeration Date | 06/13/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851821854 | NPI | - | NPPES |
| 7100342680 | Medicaid | KY | |
| 7100123440 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8732 (Kentucky) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 8778 (Kentucky) | Primary |
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