Provider Demographics
NPI:1841323268
Name:JOSEPH GORMLEY DENTAL ASSOC PLLC
Entity type:Organization
Organization Name:JOSEPH GORMLEY DENTAL ASSOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GORMLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-283-5775
Mailing Address - Street 1:7348 US HIGHWAY 42
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5560
Mailing Address - Country:US
Mailing Address - Phone:859-283-5775
Mailing Address - Fax:859-283-0017
Practice Address - Street 1:7348 US HIGHWAY 42
Practice Address - Street 2:SUITE 102
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5560
Practice Address - Country:US
Practice Address - Phone:859-283-5775
Practice Address - Fax:859-283-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty