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Organization

BREATHITT DENTAL CLINIC PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROGER CAMPBELL (OWNER)
(606) 666-4020
Entity
Organization

Contact information

Practice address
221 HIGHWAY 15 S, JACKSON, KY 41339-9600
(606) 666-4020
(606) 666-4021
Mailing address
PO BOX 854, HAZARD, KY 41702-0854
(606) 666-4020
(606) 666-4021

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6753
KY

Other

Enumeration date
11/23/2011
Last updated
11/23/2011
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