Main Street Dental, LLC
NPI #1588909642 in Vine Grove, Kentucky
Provider Information
- NPI Number
- 1588909642
- Entity Type
- Organization
- Organization Name
- Main Street Dental, LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Nov 30, 2012
- Last Updated
- Feb 12, 2014
Practice Location
- Address
- 201 W MAIN ST
- City
- Vine Grove
- State
- Kentucky
- ZIP Code
- 40175-1304
- Phone
- (270) 877-2011
Authorized Official
- Name
- MR. JEFFREY L CORKRAN
- Title
- GM/OWNER
- Phone
- (270) 877-2011
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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