Provider Demographics
NPI:1568572105
Name:SOMERSET FAMILY DENTISTRY PSC
Entity Type:Organization
Organization Name:SOMERSET FAMILY DENTISTRY PSC
Other - Org Name:DR C STEVEN HIERONYMUS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HIERONYMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-679-1204
Mailing Address - Street 1:125 BARNETT STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-679-1204
Mailing Address - Fax:606-451-9012
Practice Address - Street 1:125 BARNETT STREET
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-679-1204
Practice Address - Fax:606-451-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5256122300000X
KY2697124Q00000X
KY3491124Q00000X
KY2475124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900395Medicaid
KY60052560Medicare ID - Type Unspecified