Provider Demographics
NPI:1104989425
Name:LIFETIME DENTAL CARE OF KY PSC
Entity type:Organization
Organization Name:LIFETIME DENTAL CARE OF KY PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRED SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1779 PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7302
Mailing Address - Country:US
Mailing Address - Phone:859-689-2730
Mailing Address - Fax:
Practice Address - Street 1:1779 PATRICK DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7302
Practice Address - Country:US
Practice Address - Phone:859-689-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFETIME DENTAL CARE OF KY PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty