Organization
PEDIATRIC DENTISTRY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN D SPRADLIN DMD (PRESIDENT/OWNER)
(606) 329-1440
Entity
Organization
Contact information
Practice address
2000 CARTER AVE, ASHLAND, KY 41101-7737
(606) 329-1440
(606) 329-2441
Mailing address
PO BOX 1587, ASHLAND, KY 41105-1587
(606) 329-1440
(606) 329-2441
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5782
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60057825
—
KY
Enumeration date
08/17/2006
Last updated
08/22/2020
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