Healthcare Provider Details

I. General information

NPI: 1952385999
Provider Name (Legal Business Name): EMBRY & O CONNOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 AGIN WAY
MILTON KY
40045-1509
US

IV. Provider business mailing address

25 AGIN WAY
MILTON KY
40045-1509
US

V. Phone/Fax

Practice location:
  • Phone: 502-268-3192
  • Fax:
Mailing address:
  • Phone: 502-268-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5403
License Number StateKY

VIII. Authorized Official

Name: DR. JAMES L O CONNOR
Title or Position: DENTIST
Credential: DMD
Phone: 502-268-5903