Provider Demographics
NPI:1699989038
Name:DR WILLIAM LEE HUSKEY DDS, VILLAGE GREEN DENTAL PROFESSIONALS, LLC
Entity type:Organization
Organization Name:DR WILLIAM LEE HUSKEY DDS, VILLAGE GREEN DENTAL PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-492-7080
Mailing Address - Street 1:2150 WAPAKONETA AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1444
Mailing Address - Country:US
Mailing Address - Phone:937-492-7080
Mailing Address - Fax:937-492-7046
Practice Address - Street 1:2150 WAPAKONETA AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1444
Practice Address - Country:US
Practice Address - Phone:937-492-7080
Practice Address - Fax:937-492-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-189741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0781079Medicaid
598741OtherDELTA INSURANCE
219583462026OtherCARESOURCE
OH341644055-00OtherWORKERS COMPENSATION
OH341644055-00OtherWORKERS COMPENSATION