Provider Demographics
NPI:1902969215
Name:DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C
Entity Type:Organization
Organization Name:DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C
Other - Org Name:BOWLING GREEN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1025 ASHLEY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3406
Mailing Address - Country:US
Mailing Address - Phone:270-842-0025
Mailing Address - Fax:270-842-0093
Practice Address - Street 1:1025 ASHLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3406
Practice Address - Country:US
Practice Address - Phone:270-842-0025
Practice Address - Fax:270-842-0093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH PROFESSIONALS OF KENTUCKY, P.S.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty