Provider Demographics
NPI:1942352430
Name:BREEDING, WILLIAM GARNETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARNETT
Last Name:BREEDING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N MAIN ST STE 162
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2075
Mailing Address - Country:US
Mailing Address - Phone:606-348-6038
Mailing Address - Fax:
Practice Address - Street 1:1500 N MAIN ST STE 162
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2075
Practice Address - Country:US
Practice Address - Phone:606-348-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60050259Medicaid