Healthcare Provider Details

I. General information

NPI: 1518304294
Provider Name (Legal Business Name): WILLIAM BRUCE COMBEST DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 RICHMOND RD N STE C
BEREA KY
40403-1133
US

IV. Provider business mailing address

402 RICHMOND RD N STE C
BEREA KY
40403-1133
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-4661
  • Fax: 958-986-3579
Mailing address:
  • Phone: 859-986-4661
  • Fax: 958-986-3579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4573
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: