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General NPI Number Information
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NPI Number | 1265609374
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Entity Type | Organization
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Legal Business Name | MARK O. CUMMINS, DMD, PLLC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 326 HIGHLAND PARK DR
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City | RICHMOND
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State | KY
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Zip | 40475-3487
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Country | US
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Telephone | 859-623-2425
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Fax |
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Provider Business Mailing Address
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Address Line | 326 HIGHLAND PARK DR
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City | RICHMOND
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State | KY
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Zip | 40475-3487
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Country | US
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Telephone | 859-623-2425
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. MARK O. CUMMINS
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Credential | D.M.D.
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Telephone | 859-623-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6694
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License Number State | KY
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