Provider Demographics
NPI:1861778706
Name:TIMOTHY J. MCMAHON, D.M.D, PSC, DBA COMFORT DENTISTRY
Entity type:Organization
Organization Name:TIMOTHY J. MCMAHON, D.M.D, PSC, DBA COMFORT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-823-0111
Mailing Address - Street 1:300 ARBOR DR STE 5
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9489
Mailing Address - Country:US
Mailing Address - Phone:859-823-0111
Mailing Address - Fax:859-823-9111
Practice Address - Street 1:300 ARBOR DR STE 5
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9489
Practice Address - Country:US
Practice Address - Phone:859-823-0111
Practice Address - Fax:859-823-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60049889Medicaid