Healthcare Provider Details

I. General information

NPI: 1720068786
Provider Name (Legal Business Name): GREGORY SCOTT CAUDILL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N MAYSVILLE RD
MT STERLING KY
40353
US

IV. Provider business mailing address

PO BOX 1205
MT STERLING KY
40353
US

V. Phone/Fax

Practice location:
  • Phone: 859-498-1380
  • Fax:
Mailing address:
  • Phone: 859-498-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6455
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: