Healthcare Provider Details

I. General information

NPI: 1538453535
Provider Name (Legal Business Name): QUALITY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 DIXIE HWY
ELSMERE KY
41018-1817
US

IV. Provider business mailing address

4207 DIXIE HWY
ELSMERE KY
41018-1817
US

V. Phone/Fax

Practice location:
  • Phone: 859-342-6300
  • Fax: 859-342-6300
Mailing address:
  • Phone: 859-342-6300
  • Fax: 859-342-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY CIANCIOLO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 859-342-6300