Provider Demographics
NPI:1568688869
Name:DAILY DENTURE & DENTAL SERVICES
Entity Type:Organization
Organization Name:DAILY DENTURE & DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-843-8957
Mailing Address - Street 1:1711 DESTINY LN
Mailing Address - Street 2:STE 120
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1066
Mailing Address - Country:US
Mailing Address - Phone:270-843-8957
Mailing Address - Fax:270-843-8738
Practice Address - Street 1:1711 DESTINY LN
Practice Address - Street 2:STE 120
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1066
Practice Address - Country:US
Practice Address - Phone:270-843-8957
Practice Address - Fax:270-843-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty