Provider Demographics
NPI:1013107028
Name:HEARTLAND DENTAL CARE OF KENTUCKY - MATHEW CLIBURN DMD, PSC
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF KENTUCKY - MATHEW CLIBURN DMD, PSC
Other - Org Name:CROSSWINDS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1025 ASHLEY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3406
Mailing Address - Country:US
Mailing Address - Phone:270-783-3177
Mailing Address - Fax:270-783-3090
Practice Address - Street 1:1025 ASHLEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3406
Practice Address - Country:US
Practice Address - Phone:270-783-3177
Practice Address - Fax:270-783-3090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF KENTUCKY - MATHEW CLIBURN DMD, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty