Provider Demographics
NPI:1003961905
Name:BARBOURVILLE FAMILY DENTAL INC
Entity Type:Organization
Organization Name:BARBOURVILLE FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-545-7715
Mailing Address - Street 1:201 N ALLISON AVE
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1336
Mailing Address - Country:US
Mailing Address - Phone:606-545-7715
Mailing Address - Fax:606-546-2337
Practice Address - Street 1:201 N ALLISON AVE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1336
Practice Address - Country:US
Practice Address - Phone:606-545-7715
Practice Address - Fax:606-546-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60000924Medicaid
KY1341350OtherUNITED CONCORDIA