Provider Demographics
NPI:1588702799
Name:WILLIAM J. VERAX III, DMD, PSC
Entity type:Organization
Organization Name:WILLIAM J. VERAX III, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VERAX
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-654-5041
Mailing Address - Street 1:211 W SHELBY STREET
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040
Mailing Address - Country:US
Mailing Address - Phone:859-654-5041
Mailing Address - Fax:859-654-4186
Practice Address - Street 1:211 W SHELBY STREET
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040
Practice Address - Country:US
Practice Address - Phone:859-654-5041
Practice Address - Fax:859-654-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPLEASE CALL TO VERIF1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1235192303Medicaid
KY60052461Medicaid