Provider Demographics
NPI:1386803401
Name:MT VERNON PARTIALS AND DENTURES
Entity type:Organization
Organization Name:MT VERNON PARTIALS AND DENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-256-3026
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-1140
Mailing Address - Country:US
Mailing Address - Phone:606-256-3026
Mailing Address - Fax:
Practice Address - Street 1:571 RICHMOND STREET
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456
Practice Address - Country:US
Practice Address - Phone:606-256-3026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY835122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty