| Modern Kids Dentistry Of Elizabethtown, Pllc | |
|
151 Drexler Cir # A Elizabethtown KY 42701-7843 | |
| (859) 608-1579 | |
| Not Available |
| Full Name | Modern Kids Dentistry Of Elizabethtown, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 151 Drexler Cir # A, Elizabethtown, Kentucky |
| Authorized Official Name and Position | Justin Michael Raybould (OWNER/MANAGER) |
| Authorized Official Contact | 8593217051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Kids Dentistry Of Elizabethtown, Pllc Po Box 23293 Lexington KY 40523-3293 Ph: (859) 321-7051 | Modern Kids Dentistry Of Elizabethtown, Pllc 151 Drexler Cir # A Elizabethtown KY 42701-7843 Ph: (859) 608-1579 |
| NPI Number | 1285299149 |
|---|---|
| Provider Enumeration Date | 05/07/2019 |
| Last Update Date | 05/07/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285299149 | NPI | - | NPPES |
| 7100342680 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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