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General NPI Number Information
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NPI Number | 1851792295
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Entity Type | Organization
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Legal Business Name | MAYFIELD FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 315 S 6TH ST
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City | MAYFIELD
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State | KY
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Zip | 42066-2309
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Country | US
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Telephone | 270-247-2552
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Fax | 270-247-2514
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Provider Business Mailing Address
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Address Line | 315 S 6TH ST
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City | MAYFIELD
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State | KY
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Zip | 42066-2309
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Country | US
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Telephone | 270-247-2552
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Fax | 270-247-2514
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID TAYLOR
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Credential |
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Telephone | 270-293-2415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6905
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License Number State | KY
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