Healthcare Provider Details

I. General information

NPI: 1386803401
Provider Name (Legal Business Name): MT VERNON PARTIALS AND DENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 RICHMOND STREET
MT VERNON KY
40456
US

IV. Provider business mailing address

PO BOX 1140
MOUNT VERNON KY
40456-1140
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-3026
  • Fax:
Mailing address:
  • Phone: 606-256-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number835
License Number StateKY

VIII. Authorized Official

Name: MRS. CONNIE DOWNEY
Title or Position: OWNER/ MANAGER
Credential:
Phone: 606-256-3026