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234 Natchez Trace Ave Bowling Green KY 42103-7995 | |
| (270) 715-5437 | |
| (270) 715-0032 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 234 Natchez Trace Ave, Bowling Green, Kentucky |
| Authorized Official Name and Position | Shannon Pattee (BILLING MANAGER) |
| Authorized Official Contact | 2707155437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
234 Natchez Trace Ave Bowling Green KY 42103-7995 Ph: (270) 715-5437 | 234 Natchez Trace Ave Bowling Green KY 42103-7995 Ph: (270) 715-5437 |
| NPI Number | 1083067482 |
|---|---|
| Provider Enumeration Date | 07/20/2016 |
| Last Update Date | 06/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083067482 | NPI | - | NPPES |
| 7100429210 | Medicaid | KY | |
| 7100232870 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9156 (Kentucky) | Primary |
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