Provider Demographics
NPI:1114440450
Name:CAMPBELLSVILLE DENTAL CARE, PSC
Entity Type:Organization
Organization Name:CAMPBELLSVILLE DENTAL CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-283-4790
Mailing Address - Street 1:105 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-2237
Mailing Address - Country:US
Mailing Address - Phone:270-283-4790
Mailing Address - Fax:270-283-4864
Practice Address - Street 1:105 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2237
Practice Address - Country:US
Practice Address - Phone:270-283-4790
Practice Address - Fax:270-283-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9761261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental