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General NPI Number Information
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NPI Number | 1952450850
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY INC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 704 N MAIN STREET
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City | NICHOLASVILLE
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State | KY
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Zip | 40356
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Country | US
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Telephone | 859-881-4633
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Fax | 859-885-2663
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Provider Business Mailing Address
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Address Line | 704 N MAIN STREET
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City | NICHOLASVILLE
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State | KY
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Zip | 40356
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Country | US
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Telephone | 859-881-4633
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Fax | 859-885-2663
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DANIEL R WATKINS
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Credential | DMD
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Telephone | 859-881-4633
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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 | 5175
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License Number State | KY
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