Community Care Of Kentucky, INC
Dentist, General Practice in Madisonville, KY. Organization (NPI-2).
NPI number1053799080
StatusActive
Last updated in NPPESMay 7, 2018
Details
- NPI
- 1053799080
- Entity type
- Organization (NPI-2)
- Legal business name
- Community Care Of Kentucky, INC
- Organization subpart
- No
- Enumeration date
- May 11, 2015
- Last updated
- May 7, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
1175 S Main St Ste 4Madisonville, KY 42431-3337
Phone 270-383-5511 · Fax 270-821-9602
Mailing address
Po Box 2369Anniston, AL 36202-2369
Phone 256-741-7340 · Fax 256-741-7373
Authorized official
Jenell Stump
Manager, Licensing & Credentialing
6299995006
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