Provider Demographics
NPI:1699583773
Name:PEDIATRIC DENTISTY OF PROSPECT, PSC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTY OF PROSPECT, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMAN-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-292-1160
Mailing Address - Street 1:12927 W HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9107
Mailing Address - Country:US
Mailing Address - Phone:502-292-1160
Mailing Address - Fax:502-292-1194
Practice Address - Street 1:12927 W HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9107
Practice Address - Country:US
Practice Address - Phone:502-292-1160
Practice Address - Fax:502-292-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty