Organization
COMMONWEALTH PERIODONTICS & IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA PAUL (FINANCIAL COORDINATOR)
(606) 878-1971
Entity
Organization
Contact information
Practice address
1545 S MAIN ST, LONDON, KY 40741-2071
(606) 878-1971
(606) 864-8774
Mailing address
1545 S MAIN ST, LONDON, KY 40741-2071
(606) 878-1971
(606) 864-8774
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6224
KY
Other
Enumeration date
05/09/2016
Last updated
05/09/2016
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