# LICKING VALLEY DENTAL ASSOCIATES PSC

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

## Provider details

- **NPI number:** 1982769154
- **Authorized official:** DR. JAMES STEPHEN CLYDE DMD (PRESIDENT)
- **Authorized official phone:** (859) 234-3323

## Contact information

- **Practice address:** 114 S MAIN ST, CYNTHIANA, KY 41031-1521
- **Practice address phone:** (859) 234-3323
- **Practice address fax:** (859) 234-3332
- **Mailing address:** 114 S MAIN ST, CYNTHIANA, KY 41031-1521
- **Mailing address phone:** (859) 234-3323
- **Mailing address fax:** (859) 234-3332

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4932 | KY | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 08/22/2020