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General NPI Number Information
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NPI Number | 1851984439
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Entity Type | Organization
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Legal Business Name | DHDA HEBRON, PLLC
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 1930 PETERSBURG RD
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City | HEBRON
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State | KY
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Zip | 41048-8291
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Country | US
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Telephone | 859-586-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 5404 FARM RIDGE LN
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City | PROSPECT
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State | KY
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Zip | 40059-7617
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Country | US
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Telephone | 203-921-6141
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Fax | 502-547-7845
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PAUL T LAVELLE
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Credential | DMD
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Telephone | 203-921-6141
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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 |
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License Number State |
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