Provider Demographics
NPI:1063290369
Name:HIGHFIVE ENDODONTICS KENTUCKY, LLC
Entity type:Organization
Organization Name:HIGHFIVE ENDODONTICS KENTUCKY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DMD/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, ENDODONTIST
Authorized Official - Phone:270-534-8881
Mailing Address - Street 1:3429 LONE OAK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5775
Mailing Address - Country:US
Mailing Address - Phone:270-534-8881
Mailing Address - Fax:270-534-0115
Practice Address - Street 1:3429 LONE OAK RD STE 1
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5775
Practice Address - Country:US
Practice Address - Phone:270-534-8881
Practice Address - Fax:270-534-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty