Healthcare Provider Details

I. General information

NPI: 1952313306
Provider Name (Legal Business Name): HAROLD OWNBY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR DENTAL SERVICE ( 160-CDD )
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

4001 CHINABERRY CT
LEXINGTON KY
40513-1354
US

V. Phone/Fax

Practice location:
  • Phone: 859-281-4912
  • Fax: 859-381-5911
Mailing address:
  • Phone: 859-223-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4752
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: