Provider Demographics
NPI:1700145968
Name:MODERN DENTAL SOLUTIONS
Entity type:Organization
Organization Name:MODERN DENTAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:BEGLEY
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-864-1441
Mailing Address - Street 1:735 MEYERS BAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741
Mailing Address - Country:US
Mailing Address - Phone:606-864-1441
Mailing Address - Fax:606-864-1481
Practice Address - Street 1:735 MEYERS BAKER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3008
Practice Address - Country:US
Practice Address - Phone:606-864-1441
Practice Address - Fax:606-864-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100191350Medicaid
KY60002532Medicaid