Provider Demographics
NPI:1730342619
Name:BEDNAR, ERIC D (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:BEDNAR
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 WESTWIND WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7795
Mailing Address - Country:US
Mailing Address - Phone:502-365-3529
Mailing Address - Fax:
Practice Address - Street 1:2005 S HIGHWAY 53
Practice Address - Street 2:SUITE B
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9109
Practice Address - Country:US
Practice Address - Phone:502-253-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics