Provider Demographics
NPI:1265453658
Name:REBECCA DRISKELL-MCCOY
Entity Type:Organization
Organization Name:REBECCA DRISKELL-MCCOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LANORA
Authorized Official - Last Name:DRISKELL-MCCOY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:270-756-7950
Mailing Address - Street 1:122 W THIRD ST
Mailing Address - Street 2:P.O. BOX 429
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143
Mailing Address - Country:US
Mailing Address - Phone:270-756-7950
Mailing Address - Fax:270-756-7949
Practice Address - Street 1:122 W THIRD ST
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143
Practice Address - Country:US
Practice Address - Phone:270-756-7950
Practice Address - Fax:270-756-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7441261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental