Organization
MAIN STREET DENTAL, LLC
Active
Other names
Main Street Dental, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY L CORKRAN (GM/OWNER)
(270) 877-2011
Entity
Organization
Contact information
Practice address
201 W MAIN ST, VINE GROVE, KY 40175-1304
(270) 877-2011
Mailing address
201 W MAIN ST, VINE GROVE, KY 40175-1304
(270) 877-2011
(270) 877-2030
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
KY6807
KY
Other
Enumeration date
11/30/2012
Last updated
02/12/2014
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