Provider Demographics
NPI:1073677035
Name:HEARTLAND DENTAL CARE OF KENTUCKY - MATHEW CLIBURN DMD, PSC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF KENTUCKY - MATHEW CLIBURN DMD, PSC
Other - Org Name:HARTLAND FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1025 ASHLEY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3406
Mailing Address - Country:US
Mailing Address - Phone:270-793-0703
Mailing Address - Fax:270-793-0740
Practice Address - Street 1:1025 ASHLEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3406
Practice Address - Country:US
Practice Address - Phone:270-793-0703
Practice Address - Fax:270-793-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty