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General NPI Number Information
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NPI Number | 1235475112
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Entity Type | Organization
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Legal Business Name | BIG SANDY DENTAL CENTER PSC
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 180 TOWN MOUNTAIN RD STE 111
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City | PIKEVILLE
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State | KY
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Zip | 41501-1607
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Country | US
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Telephone | 606-509-8633
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Fax | 606-509-8634
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Provider Business Mailing Address
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Address Line | 180 TOWN MOUNTAIN RD STE 111
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City | PIKEVILLE
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State | KY
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Zip | 41501-1607
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Country | US
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Telephone | 606-509-8633
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Fax | 606-509-8634
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD A. RATLIFF
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Credential | DMD
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Telephone | 606-509-8633
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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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