Jessamine Dental | |
100 Lake St Nicholasville KY 40356-1002 | |
(859) 885-5703 | |
(859) 885-5703 |
Full Name | Jessamine Dental |
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Speciality | Dentist |
Location | 100 Lake St, Nicholasville, Kentucky |
Authorized Official Name and Position | Carol Ann Wilson (DENTIST/OWNER) |
Authorized Official Contact | 8598855703 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Jessamine Dental 100 Lake St Nicholasville KY 40356-1002 Ph: (859) 885-5703 | Jessamine Dental 100 Lake St Nicholasville KY 40356-1002 Ph: (859) 885-5703 |
NPI Number | 1114299047 |
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Provider Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114299047 | NPI | - | NPPES |
7100094910 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 8377 (Kentucky) | Primary |
1223G0001X | Dentist - General Practice | 8377 (Kentucky) | Secondary |
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