Healthcare Provider Details

I. General information

NPI: 1720582661
Provider Name (Legal Business Name): SOMERSET DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BARNETT ST
SOMERSET KY
42501-1263
US

IV. Provider business mailing address

125 BARNETT ST
SOMERSET KY
42501-1263
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8614
License Number StateKY

VIII. Authorized Official

Name: DR. JONATHAN HARDY
Title or Position: DENTIST
Credential:
Phone: 606-679-1204