Provider Demographics
NPI:1386874311
Name:OWENSBORO-DAVIESS COUNTY REGIONAL DENTAL CLINIC INC
Entity type:Organization
Organization Name:OWENSBORO-DAVIESS COUNTY REGIONAL DENTAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-691-6205
Mailing Address - Street 1:2315 MAYFAIR DR
Mailing Address - Street 2:SUITE 32
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4557
Mailing Address - Country:US
Mailing Address - Phone:270-691-6205
Mailing Address - Fax:
Practice Address - Street 1:2315 MAYFAIR DR
Practice Address - Street 2:SUITE 32
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4557
Practice Address - Country:US
Practice Address - Phone:270-691-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty