Provider Demographics
NPI:1821324112
Name:ASSOCIATES IN DENTISTRY LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-256-0288
Mailing Address - Street 1:940 W MAIN ST UNIT A
Mailing Address - Street 2:P.O. BOX 1454
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2518
Mailing Address - Country:US
Mailing Address - Phone:606-256-0288
Mailing Address - Fax:606-256-0288
Practice Address - Street 1:940 W MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2518
Practice Address - Country:US
Practice Address - Phone:606-256-0288
Practice Address - Fax:606-256-0288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATES IN DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-21
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty