PEDIATRIC DENTISTRY OF SOUTHERN KENTUCKY (NPI# 1083067482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083067482 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTISTRY OF SOUTHERN KENTUCKY |
| Other Organization Name | SKY PEDIATRIC DENTISTRY |
| Practice Address |
234 Natchez Trace Ave Bowling Green KY 42103-7995 |
| Practice Telephone | 2707155437 |
| Practice Fax Number | 2707150032 |
| Mailing Telephone | 2707155437 |
| Mailing Fax Number | 2707150032 |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2019-06-26 |
| Authorized Official Name | MRS. SHANNON PATTEE (BILLING MANAGER) |
| Authorized Official Telephone | 2707155437 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9156 | KY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100232870 | 05 | |
| KY | 7100429210 | 05 |
| Other Name | Type Code |
|---|---|
| SKY Pediatric Dentistry | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 280 Burley Ave, Hopkinsville, KY 422408725 | 2708744971 | 2708741063 |
| Street Address |
234 NATCHEZ TRACE AVE |
| City | BOWLING GREEN |
| State | KY |
| Zip Code | 42103-7995 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124142773 | Amanda Gaynor Ashley | Dentist | 234 Natchez Trace Ave, Bowling Green, KY 42103-7995 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679127781 | Kw Consulting, LLC | Counselor | 1054 Searcy Way, Suite E, Bowling Green, KY 42103 | 2019-07-26 |
| 1063999662 | Southern Kentucky Surgicenter, LLC | Clinic/Center | 484 Golden Autumn Way, Suite 100, Bowling Green, KY 42103 | 2018-07-26 |
| 1780170936 | Midsouth Psychological Services, LLC | Psychologist | 996 Wilkinson Trce Ste A8, Bowling Green, KY 42103 | 2018-07-10 |
| 1760976146 | Prorehab Inc | Clinic/Center | 1110 Wilkinson Trce Ste 101, Bowling Green, KY 42103 | 2018-06-19 |
| 1063927671 | James Toney | Counselor | 624 Eastwood St, Bowling Green, KY 42103 | 2017-12-05 |
| 1366979528 | Laura Elizabeth Compton | Optometrist | 335 New Towne Drive, Bowling Green, KY 42103 | 2017-05-18 |
| 1033562632 | Elizabette Raby | Massage Therapist | 427 Us-31 Bypass, Suite 203, Bowling Green, KY 42103 | 2016-07-19 |
| 1831572460 | Casey Edward Travelsted | Dentist | 940 Us 31 W Bypass, Bowling Green, KY 42103 | 2015-07-01 |
| 1821435074 | Robert Louis Skaggs II | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2013-05-29 |
| 1770893257 | Michelle Howell | Health Educator | 261 Moats Lane, Bowling Green, KY 42103 | 2010-10-18 |
| Find all providers in zip 42103 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740564855 | J. Scott Barbee, Dmd, Psc | Dentist | 1830 Destiny Ln Ste 119, Bowling Green, KY 42104-1089 | 2011-10-07 |
| 1477611333 | Bowling Green Pediatric Dental Group Inc | Dentist | 1221 Ridgewood Drive, Suite B, Bowling Green, OH 43402-2667 | 2006-12-04 |
| 1487750956 | Erin Courtney Elliott | Dentist | 120 Callaway Ct, Bowling Green, KY 42103 | 2006-09-15 |
| 1659480275 | Randall Harley Elliott | Dentist | 120 Callaway Court, Bowling Green, KY 42103 | 2006-08-29 |
| 1538505615 | Matthew Nicholson Damin | Dentist | 1830 Destiny Ln, Suite 119, Bowling Green, KY 42104-1087 | 2013-05-16 |
| 1336481720 | Frank D Tuzzio IIi | Dentist | 1221 Ridgewood Dr, Suite B, Bowling Green, OH 43402-2787 | 2013-03-23 |
| 1205997236 | Jeffrey Scott Barbee | Dentist | 1830 Destiny Ln, St 119, Bowling Green, KY 42104 | 2006-12-13 |
| 1003974965 | Frank Louis Pace Jr. | Dentist | 1221 Ridgewood Drive, Suite B, Bowling Green, OH 43402-2667 | 2006-12-04 |
| 1821107442 | Drs Erin and Randy Elliott Pediatric Dentistry | Dentist | 120 Callaway Court, Bowling Green, KY 42103 | 2006-08-29 |
| 1558356030 | Jack Allen Whittaker | Dentist | 960 W Wooster St, Ste. 201, Bowling Green, OH 43402-2644 | 2005-09-12 |
| Find all providers in BOWLING GREEN | ||||
| City | BOWLING GREEN |
| Zip Code | 42103 |
Please comment or provide details below to improve the information on PEDIATRIC DENTISTRY OF SOUTHERN KENTUCKY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.