Provider Demographics
NPI:1790333425
Name:SKY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SKY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-715-5437
Mailing Address - Street 1:727 US 31W BYP STE 101
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4963
Mailing Address - Country:US
Mailing Address - Phone:270-783-5280
Mailing Address - Fax:
Practice Address - Street 1:727 US 31W BYP STE 101
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4963
Practice Address - Country:US
Practice Address - Phone:270-783-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty