Healthcare Provider Details

I. General information

NPI: 1588774848
Provider Name (Legal Business Name): DARRELL H RISNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DOGWOOD ST
HYDEN KY
41749
US

IV. Provider business mailing address

PO BOX 941 8 DOGWOOD ST
HYDEN KY
41749
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-3550
  • Fax: 606-672-3566
Mailing address:
  • Phone: 606-672-3550
  • Fax: 606-672-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5259
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5259
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: