Provider Demographics
NPI:1346083276
Name:HERITAGE DENTAL CENTER - PETERSBURG
Entity type:Organization
Organization Name:HERITAGE DENTAL CENTER - PETERSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-3120
Mailing Address - Street 1:125 SAINT MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-3566
Mailing Address - Country:US
Mailing Address - Phone:859-441-3120
Mailing Address - Fax:
Practice Address - Street 1:1930 PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-8291
Practice Address - Country:US
Practice Address - Phone:859-441-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental