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General NPI Number Information
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NPI Number | 1447113519
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Entity Type | Organization
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Legal Business Name | KY DENTAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 302 E CARSON ST STE 100
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City | CARSON
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State | CA
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Zip | 90745-8507
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Country | US
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Telephone | 559-393-1929
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 994
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City | MORRO BAY
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State | CA
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Zip | 93443-0994
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Country | US
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Telephone | 559-393-1929
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VEROCK KY
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Credential | DDS
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Telephone | 559-393-1929
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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 |
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License Number State |
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