Organization
COMMUNITY CARE OF KENTUCKY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENELL STUMP (MANAGER, LICENSING & CREDENTIALING)
(270) 383-5511
Entity
Organization
Contact information
Practice address
122 S LEE TROVER TODD JR HWY, EARLINGTON, KY 42410-1557
(270) 383-5511
Mailing address
PO BOX 2369, ANNISTON, AL 36202-2369
(256) 741-7340
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/11/2015
Last updated
01/15/2016
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