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General NPI Number Information
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NPI Number | 1639346257
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Entity Type | Organization
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Legal Business Name | BOTTS ELEMENTARY DENTAL CLINIC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | HWY 460
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City | DENNISTON
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State | KY
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Zip | 40316
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Country | US
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Telephone | 606-768-8058
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Fax | 606-768-8100
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Provider Business Mailing Address
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Address Line | BOX 39
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City | DENNISTON
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State | KY
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Zip | 40316
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Country | US
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Telephone | 606-674-6396
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Fax | 606-674-3071
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Authorized Official
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Title or Position | ASST. DIRECTOR
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Name | MR. GREGORY DEAN BREWER
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Credential |
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Telephone | 606-674-6396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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