Provider Demographics
NPI:1245314863
Name:CORMNEY, BEN G (DMD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:G
Last Name:CORMNEY
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 1:519 HAMPTON WAY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8885
Mailing Address - Country:US
Mailing Address - Phone:859-624-1170
Mailing Address - Fax:859-626-1234
Practice Address - Street 1:519 HAMPTON WAY
Practice Address - Street 2:SUITE 10
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8885
Practice Address - Country:US
Practice Address - Phone:859-624-1170
Practice Address - Fax:859-626-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60053527Medicaid