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General NPI Number Information
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NPI Number | 1720444532
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Entity Type | Organization
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Legal Business Name | OHIO COUNTY FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 1221 N MAIN ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-8955
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Country | US
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Telephone | 270-274-3379
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Fax | 270-274-4600
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Provider Business Mailing Address
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Address Line | 1221 N MAIN ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-8955
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Country | US
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Telephone | 270-274-3379
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Fax | 270-274-4600
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN DENISE STEVENS
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Credential |
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Telephone | 270-256-5757
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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 | 4281
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License Number State | KY
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