Provider Demographics
NPI:1013443894
Name:BARDSTOWN ON CALL DENTAL
Entity type:Organization
Organization Name:BARDSTOWN ON CALL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CLAYWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-349-3289
Mailing Address - Street 1:621 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1750
Mailing Address - Country:US
Mailing Address - Phone:502-349-3289
Mailing Address - Fax:502-348-7260
Practice Address - Street 1:621 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1750
Practice Address - Country:US
Practice Address - Phone:502-349-3289
Practice Address - Fax:502-348-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty