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General NPI Number Information
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NPI Number | 1194064493
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES FAMILY & COSMETIC DENTISTRY PSC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 83 OAK RIDGE CT
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City | PRESTONSBURG
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State | KY
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Zip | 41653-8595
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Country | US
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Telephone | 606-886-0300
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Fax | 606-886-9334
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Provider Business Mailing Address
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Address Line | 83 OAK RIDGE CT
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City | PRESTONSBURG
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State | KY
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Zip | 41653-8595
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Country | US
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Telephone | 606-886-0300
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Fax | 606-886-9334
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MISTY DAWN CLARK
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Credential | DMD
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Telephone | 606-886-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8481
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License Number State | KY
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