# COVINGTON FAMILY DENTAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043527351
- **Authorized official:** MR. QUN WANG (PRESIDENT)
- **Authorized official phone:** (847) 828-0213

## Contact information

- **Practice address:** 300 PIKE ST, COVINGTON, KY 41011-2127
- **Practice address phone:** (859) 491-7453
- **Mailing address:** 1355 GAIL DR, BUFFALO GROVE, IL 60089-1141
- **Mailing address phone:** (847) 828-0213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 09/08/2010
- **Last updated:** 11/24/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100138020 | — | KY |