| Modern Kids Dentistry | |
|
4384 Clearwater Way Suite 150 Lexington KY 40515-6477 | |
| (859) 321-7051 | |
| Not Available |
| Full Name | Modern Kids Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4384 Clearwater Way, Lexington, Kentucky |
| Authorized Official Name and Position | Justin Michael Raybould (PRESIDENT/CEO) |
| Authorized Official Contact | 8593217051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Kids Dentistry 725 Beechmont Rd Suite 150 Lexington KY 40502-2837 Ph: (859) 321-7051 | Modern Kids Dentistry 4384 Clearwater Way Suite 150 Lexington KY 40515-6477 Ph: (859) 321-7051 |
| NPI Number | 1174912224 |
|---|---|
| Provider Enumeration Date | 01/13/2015 |
| Last Update Date | 04/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174912224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8732 (Kentucky) | Primary |
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