Provider Demographics
NPI:1588546469
Name:SOUTHERN TRAVEL SURGERY PLLC
Entity type:Organization
Organization Name:SOUTHERN TRAVEL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRIEND
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-715-1322
Mailing Address - Street 1:321 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:SCIENCE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:42553-9117
Mailing Address - Country:US
Mailing Address - Phone:859-583-2744
Mailing Address - Fax:
Practice Address - Street 1:54 IMAGING DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2871
Practice Address - Country:US
Practice Address - Phone:859-583-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty