Healthcare Provider Details

I. General information

NPI: 1245636174
Provider Name (Legal Business Name): RICK CANTY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201A S WASHINGTON ST
CLINTON KY
42031-1440
US

IV. Provider business mailing address

PO BOX 217
CLINTON KY
42031-0217
US

V. Phone/Fax

Practice location:
  • Phone: 270-653-4600
  • Fax:
Mailing address:
  • Phone: 270-653-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4384
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: