Healthcare Provider Details

I. General information

NPI: 1275460024
Provider Name (Legal Business Name): JOHN ROBERT DIALS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SWEET HOLLOW RD
CORBIN KY
40701-5143
US

IV. Provider business mailing address

15 SWEET HOLLOW RD
CORBIN KY
40701-5143
US

V. Phone/Fax

Practice location:
  • Phone: 606-389-8910
  • Fax:
Mailing address:
  • Phone: 606-389-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: