Provider Demographics
NPI:1306162409
Name:COMMONWEALTH DENTAL, PSC
Entity type:Organization
Organization Name:COMMONWEALTH DENTAL, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-283-1911
Mailing Address - Street 1:7348 US HIGHWAY 42 STE 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1965
Mailing Address - Country:US
Mailing Address - Phone:859-283-1911
Mailing Address - Fax:859-283-2218
Practice Address - Street 1:7348 US HIGHWAY 42 STE 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1965
Practice Address - Country:US
Practice Address - Phone:859-283-1911
Practice Address - Fax:859-283-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty