Provider Demographics
NPI:1245734763
Name:TATES CREEK DENTAL, PSC
Entity Type:Organization
Organization Name:TATES CREEK DENTAL, PSC
Other - Org Name:HARRODSBURG FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-734-7709
Mailing Address - Street 1:517 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-2186
Mailing Address - Country:US
Mailing Address - Phone:859-734-7709
Mailing Address - Fax:
Practice Address - Street 1:517 LEGION DR
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2186
Practice Address - Country:US
Practice Address - Phone:859-734-7709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TATES CREEK DENTAL, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty