Healthcare Provider Details

I. General information

NPI: 1568572105
Provider Name (Legal Business Name): SOMERSET FAMILY DENTISTRY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BARNETT STREET
SOMERSET KY
42501
US

IV. Provider business mailing address

125 BARNETT STREET
SOMERSET KY
42501
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1204
  • Fax: 606-451-9012
Mailing address:
  • Phone: 606-679-1204
  • Fax: 606-451-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5256
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2697
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3491
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2475
License Number StateKY

VIII. Authorized Official

Name: DR. CHARLES STEVEN HIERONYMUS
Title or Position: DOCTOR OWNER
Credential: DMD
Phone: 606-679-1204