MEDICARE: DR. DAVID NEAL WAUGH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7334	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649260464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID NEAL WAUGH DMD

Provider Business Mailing Address
First Line	:	6541 LEITCHFIELD RD
Second Line	:
City	:	CECILIA
State	:	KY
Zip	:	42724-9554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1768
Country	:	US
Telephone Number	:	502-778-7414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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