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General NPI Number Information
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NPI Number | 1194066324
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Entity Type | Organization
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Legal Business Name | WESTERN KENTUCKY UNIVERSITY
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1906 COLLEGE HEIGHTS BLVD # 21038 ACADEMIC COMPLEX 201
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1000
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Country | US
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Telephone | 270-745-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 COLLEGE HEIGHTS BLVD # 21038 ACADEMIC COMPLEX 201
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MATTHEW HUNT
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Credential | M.A.
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Telephone | 270-745-4138
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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 |
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License Number State |
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