Provider Demographics
NPI:1861543027
Name:DENTAL CENTER OF FLORENCE KENTUCKY
Entity type:Organization
Organization Name:DENTAL CENTER OF FLORENCE KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-282-9741
Mailing Address - Street 1:8076 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1474
Mailing Address - Country:US
Mailing Address - Phone:859-282-9741
Mailing Address - Fax:859-282-2171
Practice Address - Street 1:8076 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1474
Practice Address - Country:US
Practice Address - Phone:859-282-9741
Practice Address - Fax:859-282-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60044369Medicaid