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General NPI Number Information
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NPI Number | 1053612226
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Entity Type | Organization
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Legal Business Name | LAKER DENTAL
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 54 IMAGING DR
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City | SOMERSET
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State | KY
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Zip | 42503-2871
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Country | US
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Telephone | 606-451-2273
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Fax | 606-451-9322
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Provider Business Mailing Address
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Address Line | 54 IMAGING DR
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City | SOMERSET
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State | KY
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Zip | 42503-2871
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Country | US
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Telephone | 606-451-2273
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Fax | 606-451-9322
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT BRIAN GRIPPE
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Credential | DMD
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Telephone | 606-451-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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