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General NPI Number Information
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NPI Number | 1700145968
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL SOLUTIONS
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 735 MEYERS BAKER RD
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City | LONDON
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State | KY
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Zip | 40741-3008
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Country | US
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Telephone | 606-864-1441
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Fax | 606-864-1481
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Provider Business Mailing Address
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Address Line | 735 MEYERS BAKER ROAD
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City | LONDON
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State | KY
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Zip | 40741
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Country | US
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Telephone | 606-864-1441
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Fax | 606-864-1481
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA BEGLEY COUCH
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Credential | DMD
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Telephone | 606-864-1441
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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 | 80000
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License Number State | KY
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