Provider Demographics
NPI:1720293673
Name:PETREY, RODNEY
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
Last Name:PETREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 RAMBLER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2440
Mailing Address - Country:US
Mailing Address - Phone:859-277-0011
Mailing Address - Fax:859-277-1703
Practice Address - Street 1:2011 RAMBLER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2440
Practice Address - Country:US
Practice Address - Phone:859-277-0011
Practice Address - Fax:859-277-1703
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice