Provider Demographics
NPI:1306936844
Name:TACKETT, DENVER DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:DENVER
Middle Name:DAVID
Last Name:TACKETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0596
Mailing Address - Country:US
Mailing Address - Phone:606-949-1674
Mailing Address - Fax:
Practice Address - Street 1:138 PARKVIEW DR BLDG 1
Practice Address - Street 2:
Practice Address - City:MINNIE
Practice Address - State:KY
Practice Address - Zip Code:41651-8303
Practice Address - Country:US
Practice Address - Phone:606-949-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist