Provider Demographics
NPI:1154607190
Name:CYNTHIANA DENTAL CENTER
Entity type:Organization
Organization Name:CYNTHIANA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEWELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-987-3290
Mailing Address - Street 1:111 KY HIGHWAY 32 W STE 2
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-8574
Mailing Address - Country:US
Mailing Address - Phone:859-234-9944
Mailing Address - Fax:
Practice Address - Street 1:111 KY HIGHWAY 32 W STE 2
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-8574
Practice Address - Country:US
Practice Address - Phone:859-234-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8719122300000X, 1223G0001X
KY6683122300000X, 1223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty