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General NPI Number Information
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NPI Number | 1881737997
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Entity Type | Organization
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Legal Business Name | PEBBLE CREEK FAMILY DENTISTRY, P.L.L.C.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 2100 N MAIN ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-9007
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Country | US
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Telephone | 270-825-2686
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Fax | 270-821-7306
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Provider Business Mailing Address
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Address Line | 2100 N MAIN ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-9007
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Country | US
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Telephone | 270-825-2686
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Fax | 270-821-7306
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD J. SEGEBARTH
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Credential | D.D.S.
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Telephone | 270-825-2686
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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 | 4359
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License Number State | KY
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