| Pediatric Dentistry, Psc | |
|
2000 Carter Ave Ashland KY 41101-7737 | |
| (606) 329-1440 | |
| (606) 329-2441 |
| Full Name | Pediatric Dentistry, Psc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2000 Carter Ave, Ashland, Kentucky |
| Authorized Official Name and Position | Glenn D Spradlin (PRESIDENT/OWNER) |
| Authorized Official Contact | 6063291440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry, Psc Po Box 1587 Ashland KY 41105-1587 Ph: (606) 329-1440 | Pediatric Dentistry, Psc 2000 Carter Ave Ashland KY 41101-7737 Ph: (606) 329-1440 |
| NPI Number | 1487767901 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487767901 | NPI | - | NPPES |
| 60057825 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5782 (Kentucky) | Primary |
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