Provider Demographics
NPI:1790078905
Name:DOWELL FAMILY DENTISTRY, PSC
Entity Type:Organization
Organization Name:DOWELL FAMILY DENTISTRY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-877-1466
Mailing Address - Street 1:PO BOX 3320
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-3320
Mailing Address - Country:US
Mailing Address - Phone:606-877-1466
Mailing Address - Fax:606-878-2113
Practice Address - Street 1:615 MEYERS BAKER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3006
Practice Address - Country:US
Practice Address - Phone:606-877-1466
Practice Address - Fax:606-878-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80951223G0001X
KY82301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty