MEDICARE: WILLIAM BRUCE COMBEST DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4573	KY

General Provider Information

NPI Number	:	1518304294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BRUCE COMBEST DMD

Provider Business Mailing Address
First Line	:	402 RICHMOND RD N STE C
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1133
Country	:	US
Telephone Number	:	859-986-4661
Fax Number	:	958-986-3579

Provider Business Practice Location Address
First Line	:	402 RICHMOND RD N STE C
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1133
Country	:	US
Telephone Number	:	859-986-4661
Fax Number	:	958-986-3579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	06/13/2013

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