Provider Demographics
NPI:1992871644
Name:VETERANS PARK FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:VETERANS PARK FAMILY DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:FALLAHZADEH
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-272-0800
Mailing Address - Street 1:4804 BRENNEN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6281
Mailing Address - Country:US
Mailing Address - Phone:859-913-4472
Mailing Address - Fax:
Practice Address - Street 1:4384 CLEARWATER WAY
Practice Address - Street 2:STE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6337
Practice Address - Country:US
Practice Address - Phone:859-272-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty