Organization
SMITHS GROVE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY PHILLIP WALDEN DMD (OWNER)
(270) 563-4819
Entity
Organization
Contact information
Practice address
148 VINCENT ST, SMITHS GROVE, KY 42171-8183
(270) 563-4819
(270) 563-0088
Mailing address
PO BOX 370, SMITHS GROVE, KY 42171-0370
(270) 563-4819
(270) 563-0088
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9168
KY
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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