Organization Name: | J. MARK HUNTSMAN DMD PSC |
NPI Number: | 1609925346 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES MARK HUNTSMAN (PRESIDENT) |
Mailing Address: | 199 W Main St Scottsville |
State: | KY US |
Postal Code: | 421641120 |
Phone Number: | 2702373655 |
Fax Number: | 2702373278 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 4123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |