Healthcare Provider Details

I. General information

NPI: 1548344542
Provider Name (Legal Business Name): PRECISION DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 S MAIN ST
DRY RIDGE KY
41035-9406
US

IV. Provider business mailing address

PO BOX 238 139 SOUTH MAIN ST.
DRY RIDGE KY
41035-0238
US

V. Phone/Fax

Practice location:
  • Phone: 859-824-7133
  • Fax: 859-824-7134
Mailing address:
  • Phone: 859-824-7133
  • Fax: 859-824-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4513
License Number StateKY

VIII. Authorized Official

Name: DR. WILLIAM KENDALL RICH
Title or Position: PRESIDENT
Credential: DMD
Phone: 859-824-7133