Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6183 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 6183 | KY |
NPI | 1588764740 |
---|---|
Provider Name | Dr. Jeffrey B Dembo |
First Address | Lexington, KY 40536-0297 |
Second Address | Lexington, KY 40536-0297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60061835 | (05) | KY |
64061831 | (05) | KY |
T01228 | (02) | KY |