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General NPI Number Information
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NPI Number | 1396224580
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTISTRY AND COSMETIC CENTER
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 230 CONNECTOR RD
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City | GEORGETOWN
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State | KY
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Zip | 40324-9722
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Country | US
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Telephone | 859-509-0750
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Fax | 859-987-6800
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Provider Business Mailing Address
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Address Line | 230 CONNECTOR RD
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City | GEORGETOWN
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State | KY
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Zip | 40324-9722
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Country | US
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Telephone | 859-509-0750
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Fax | 859-987-6800
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Authorized Official
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Title or Position | DENTIST
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Name | JEWELL MEADE
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Credential | DMD
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Telephone | 859-509-0750
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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 | 6683
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License Number State | KY
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