PEDIATRIC DENTISTRY OF SHELBYVILLE (NPI# 1770748790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770748790 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTISTRY OF SHELBYVILLE |
| Practice Address |
141 Stonecrest Rd Shelbyville KY 40065-8164 |
| Practice Telephone | 5026334441 |
| Practice Fax Number | 5026334470 |
| Mailing Telephone | 5026334441 |
| Mailing Fax Number | 5026334470 |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2009-10-08 |
| Authorized Official Name | MS. AMY E RAISOR (OFFICE MANAGER) |
| Authorized Official Telephone | 5026334441 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
7277 | KY | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
7601 | KY | Dental Providers |
| Street Address |
141 STONECREST RD |
| City | SHELBYVILLE |
| State | KY |
| Zip Code | 40065-8164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598767030 | Kirby Chambers Hoetker | Dentist | 141 Stonecrest Rd, Shelbyville, KY 40065-8164 | 2005-08-15 |
| 1699959221 | Alice Barton Creque | Physical Therapist | 141 Stonecrest Rd, Unit 2, Shelbyville, KY 40065-8166 | 2007-12-18 |
| 1598949133 | Lori England | Physical Therapist | 141 Stonecrest Rd, Unit 2, Shelbyville, KY 40065-8166 | 2007-12-18 |
| 1508928300 | Max Performance Physical Therapy and Sports Rehab, LLC | Physical Therapist | 141 Stonecrest Rd, Unit 2, Shelbyville, KY 40065 | 2006-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013348242 | Elisa Sykes-brees | Counselor | 250 Alpine Drive, Shelbyville, KY 40065 | 2013-12-13 |
| 1073800512 | Mimi Y. R. Rayburn | Nurse Practitioner | 865 Old Taylorsville Rd, Shelbyville, KY 40065 | 2011-07-05 |
| 1124310677 | Amanda B Dassel | Pharmacist | 1605 Midland Trail, Shelbyville, KY 40065 | 2011-05-03 |
| 1639468812 | Tia M Alton | Pediatrics | 150 Frankfort Rd Ste 101, Shelbyville, KY 40065 | 2011-03-29 |
| 1699073338 | Emily Ann Waits | Dietitian, Registered | 615 11th Street, Shelby County Health Dept., Shelbyville, KY 40065 | 2011-03-04 |
| 1124335401 | Kelli L. Fetter | Occupational Therapist | 1900 Midland Trail, Ste 1 & 2, Shelbyville, KY 40065 | 2010-09-08 |
| 1083939425 | Marilyn Louise Rhoads | Licensed Practical Nurse | 615 Washington Street, Mercy Clinic, Shelbyville, KY 40065 | 2010-03-29 |
| 1154525277 | Dorman Preschool Center | Early Intervention Provider Agency | 719 Burks Branch Road, Shelbyville, KY 40065 | 2007-06-13 |
| 1194946368 | Joanna Sames | Pharmacist | 16 Village Plaza, Shelbyville, KY 40065 | 2007-05-02 |
| 1033298922 | Robyn A Keeling | Dentist | 502 Mount Eden Rd, Shelbyville, KY 40065 | 2006-11-03 |
| Find all providers in zip 40065 | ||||
| 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 |
|---|---|---|---|---|
| 1316463607 | Emhardt Pediatric Dentistry LLC | Dentist | 1818 N Riley Hwy Ste B, Shelbyville, IN 46176-8572 | 2017-08-17 |
| 1598767030 | Kirby Chambers Hoetker | Dentist | 141 Stonecrest Rd, Shelbyville, KY 40065-8164 | 2005-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518599802 | Derby City Pediatric Dentistry, Pllc | Dentist | 2120 High Wickham Pl Ste 103, Louisville, KY 40245-5903 | 2020-02-05 |
| 1588204655 | Kids Dentistree of Ky LLC | Dentist | 8727 Old Bardstown Rd, Louisville, KY 40291-4490 | 2020-01-07 |
| 1033775374 | Alex Mayes Young Dmd Pllc | Dentist | 7400 Us 42, Florence, KY 41042-1906 | 2019-05-13 |
| 1285299149 | Modern Kids Dentistry of Elizabethtown, Pllc | Dentist | 151 Drexler Cir # A, Elizabethtown, KY 42701-7843 | 2019-05-07 |
| 1780141580 | Morgan Marie Nowery | Dentist | 134 Gillette Ave, Louisville, KY 40214-1914 | 2019-02-27 |
| 1578030995 | Huda Hussain Alkuhl | Dentist | 501 S Preston St Fl 3, Louisville, KY 40202-1701 | 2018-10-24 |
| 1073099792 | Lake Cumberland Pediatric Dentistry | Dentist | 100 Hardin Ln Ste A, Somerset, KY 42503-3812 | 2018-07-16 |
| 1376032557 | Devon Cooper | Dentist | 5495 N Bend Rd Ste 102, Burlington, KY 41005-9378 | 2018-05-03 |
| 1609363795 | Alexandria Gene Maxson | Dentist | 1275 Hallwood Dr, Morehead, KY 40351-7370 | 2018-04-16 |
| 1831606094 | Djr2 Professional Limited Liability Company | Dentist | 303 S 4th St Ste 201, Danville, KY 40422-2091 | 2018-01-09 |
| Find all providers with the same taxonomy | ||||
| City | SHELBYVILLE |
| Zip Code | 40065 |
Please comment or provide details below to improve the information on PEDIATRIC DENTISTRY OF SHELBYVILLE.
| 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.