Provider Demographics
NPI:1154594901
Name:CUMBDENT, PSC
Entity type:Organization
Organization Name:CUMBDENT, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNELEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYME
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-227-4605
Mailing Address - Street 1:54 IMAGING DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-451-2273
Mailing Address - Fax:606-451-9322
Practice Address - Street 1:54 IMAGING DRIVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-451-2273
Practice Address - Fax:606-451-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7471122300000X
KY33011223G0001X
KY74111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty