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General NPI Number Information
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NPI Number | 1912006743
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Entity Type | Individual
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Provider Name | JERRY WAYNE CAUDILL D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 51 CARRIE LN
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City | CAMPBELLSBURG
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State | KY
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Zip | 40011-6218
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Country | US
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Telephone | 502-414-1114
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Fax | 502-236-0555
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Provider Business Mailing Address
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Address Line | 51 CARRIE LN
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City | CAMPBELLSBURG
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State | KY
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Zip | 40011-6218
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Country | US
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Telephone | 502-414-1114
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Fax | 502-236-0555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5408
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License Number State | KY
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