=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871895243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECONOMY DENTURES PLUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2010
-----------------------------------------------------
Last Update Date | 11/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6363 KY ROUTE 1428
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41601-0066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-874-0678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 66 6363 KY ROUTE 1428
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41601-0066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-874-0678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESDENT /OWNER
-----------------------------------------------------
Name | MR. JOCOB P COMBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-874-0678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0844
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------