Provider Demographics
NPI:1821316910
Name:COMMONWEALTH FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COMMONWEALTH FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDEBT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOWLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-783-0182
Mailing Address - Street 1:750 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351
Mailing Address - Country:US
Mailing Address - Phone:606-783-0182
Mailing Address - Fax:606-783-0272
Practice Address - Street 1:750 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351
Practice Address - Country:US
Practice Address - Phone:606-783-0182
Practice Address - Fax:606-783-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100126130Medicaid
KY7100009100Medicaid