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General NPI Number Information
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NPI Number | 1720582661
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Entity Type | Organization
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Legal Business Name | SOMERSET DENTAL PLLC
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 125 BARNETT ST
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City | SOMERSET
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State | KY
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Zip | 42501-1263
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Country | US
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Telephone | 606-679-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 125 BARNETT ST
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City | SOMERSET
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State | KY
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Zip | 42501-1263
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Country | US
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Telephone | 606-679-1204
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JONATHAN HARDY
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Credential |
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Telephone | 606-679-1204
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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 | 8614
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License Number State | KY
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