| Jessamine Dental | |
|
100 Lake St Nicholasville KY 40356-1002 | |
| (859) 885-5703 | |
| (859) 885-5703 |
| Full Name | Jessamine Dental |
|---|---|
| Speciality | Dentist |
| Location | 100 Lake St, Nicholasville, Kentucky |
| Authorized Official Name and Position | Carol Ann Wilson (DENTIST/OWNER) |
| Authorized Official Contact | 8598855703 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessamine Dental 100 Lake St Nicholasville KY 40356-1002 Ph: (859) 885-5703 | Jessamine Dental 100 Lake St Nicholasville KY 40356-1002 Ph: (859) 885-5703 |
| NPI Number | 1114299047 |
|---|---|
| Provider Enumeration Date | 02/08/2012 |
| Last Update Date | 02/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114299047 | NPI | - | NPPES |
| 7100094910 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 8377 (Kentucky) | Primary |
| 1223G0001X | Dentist - General Practice | 8377 (Kentucky) | Secondary |
News Archive
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