# CLINTON DENTAL CLINIC,INC.

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

## Provider details

- **NPI number:** 1073679866
- **Authorized official:** DR. RICKEY ALLAN CANTY D.M.D. (OWNER-DENTIST)
- **Authorized official phone:** (270) 653-4600

## Contact information

- **Practice address:** 201 S WASHINGTON ST, CLINTON, KY 42031-1440
- **Practice address phone:** (270) 653-4600
- **Practice address fax:** (270) 653-2778
- **Mailing address:** PO BOX 217, CLINTON, KY 42031-0217
- **Mailing address phone:** (270) 653-4600
- **Mailing address fax:** (270) 653-2778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4384 | KY | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 03/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6004384100 | — | KY |