Provider Demographics
NPI:1982972055
Name:RIGDON FAMILY DENTAL, INC
Entity Type:Organization
Organization Name:RIGDON FAMILY DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-389-2855
Mailing Address - Street 1:124 S BRADY ST
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-1504
Mailing Address - Country:US
Mailing Address - Phone:270-389-2855
Mailing Address - Fax:270-997-4856
Practice Address - Street 1:124 S BRADY ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1504
Practice Address - Country:US
Practice Address - Phone:270-389-2855
Practice Address - Fax:270-997-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60068897Medicaid