Healthcare Provider Details

I. General information

NPI: 1912037383
Provider Name (Legal Business Name): ORDIE L DAY II D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 N DIXIE AVE SUITE 207
ELIZABETHTOWN KY
42701-2520
US

IV. Provider business mailing address

914 N DIXIE AVE SUITE 207
ELIZABETHTOWN KY
42701-2520
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-6969
  • Fax: 270-769-6401
Mailing address:
  • Phone: 270-737-6969
  • Fax: 270-769-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4738
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: