Individual
JIM S CAUDILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
359 NORTH HIGHWAY, HAZARD, KY 41701
(606) 436-3432
Mailing address
PO BOX 1089, HAZARD, KY 41702
(606) 436-3432
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4317
KY
1223G0001X
General Practice Dentistry
Primary
4317
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60043171
—
KY
Enumeration date
04/03/2007
Last updated
12/19/2007
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