MODERN KIDS DENTISTRY OF NICHOLASVILLE (NPI# 1851821854) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851821854 |
| Entity Type | Organization |
| Organization Name | MODERN KIDS DENTISTRY OF NICHOLASVILLE |
| Practice Address |
611 N Main St Nicholasville KY 40356-1025 |
| Practice Telephone | (859) 759-4428 |
| Mailing Telephone | 8597594428 |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2017-06-13 |
| Authorized Official Name | DR. JUSTIN MICHAEL RAYBOULD (MANAGER) |
| Authorized Official Telephone | 8593217051 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
8732 | KY | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
8778 | KY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100342680 | 05 | |
| KY | 7100123440 | 05 |
| Street Address |
611 N MAIN ST |
| City | NICHOLASVILLE |
| State | KY |
| Zip Code | 40356-1025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972871465 | Eric F Huffman Dmd Psc | Clinic/Center | 611 N Main St, Nicholasville, KY 40356-1025 | 2011-12-12 |
| 1417085994 | Eric F Huffman | Dentist | 611 N Main St, Nicholasville, KY 40356-1025 | 2007-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609414507 | Samantha Johanne Tatum | Occupational Therapist | 610 E Brannon Road Suite 200, Nicholasville, KY 40356 | 2019-12-11 |
| 1083117279 | Michelle M Harrison | Counselor | 100 W. Maple Street, Nicholasville, KY 40356 | 2018-03-14 |
| 1427598226 | Margaret Osbourne | Counselor | 101a Wind Haven Drive, Suite 203, Nicholasville, KY 40356 | 2017-02-28 |
| 1265818421 | Amanda Marie Sciretta | Speech-Language Pathologist | 105 Windhaven Drive, Suite 1, Nicholasville, KY 40356 | 2015-08-10 |
| 1538568720 | Carmen T Wurtz | Physical Therapist | 602 Keene Centre Dr, Nicholasville, KY 40356 | 2014-08-14 |
| 1780093609 | Kristin Borrelli | Psychologist | 2513 Bethel Rd, Nicholasville, KY 40356 | 2014-08-05 |
| 1003169343 | Megan Brittany Young | Occupational Therapist | 1123 Holloway Lane, Nicholasville, KY 40356 | 2012-10-24 |
| 1801145412 | Brannon Crossing Family Dental, Pllc | Dentist | 231 East Brannon Rd, Nicholasville, KY 40356 | 2012-08-29 |
| 1821392135 | The Methodist Home of Ky | Case Management | 1115 Ashgrove Road, Nicholasville, KY 40356 | 2010-12-29 |
| 1083934053 | Benjamin J Heckman | Dentist | 117 Bryant Dr, Nicholasville, KY 40356 | 2010-06-01 |
| Find all providers in zip 40356 | ||||
| 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 |
|---|---|---|---|---|
| 1801114061 | Stephanie Louise Werner | Dentist | 106 Fairfield Dr, Nicholasville, KY 40356-8842 | 2010-05-12 |
| 1871857813 | Rebecca T. Wheeler, Dmd | Dentist | 106 Fairfield Dr, Nicholasville, KY 40356-8842 | 2012-06-25 |
| 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 | NICHOLASVILLE |
| Zip Code | 40356 |
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| 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.