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Organization
COVINGTON FAMILY DENTAL, INC
Active
Organization
COVINGTON FAMILY DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUN WANG (PRESIDENT)
(847) 828-0213
Entity
Organization
Contact information
Practice address
300 PIKE ST, COVINGTON, KY 41011-2127
(859) 491-7453
Mailing address
1355 GAIL DR, BUFFALO GROVE, IL 60089-1141
(847) 828-0213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100138020
—
KY
Enumeration date
09/08/2010
Last updated
11/24/2010
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