| Main Street Dental, Llc | |
|
201 W Main St Vine Grove KY 40175-1304 | |
| (270) 877-2011 | |
| Not Available |
| Full Name | Main Street Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 201 W Main St, Vine Grove, Kentucky |
| Authorized Official Name and Position | Jeffrey L Corkran (GM/OWNER) |
| Authorized Official Contact | 2708772011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Dental, Llc 201 W Main St Vine Grove KY 40175-1304 Ph: (270) 877-2011 | Main Street Dental, Llc 201 W Main St Vine Grove KY 40175-1304 Ph: (270) 877-2011 |
| NPI Number | 1588909642 |
|---|---|
| Provider Enumeration Date | 11/30/2012 |
| Last Update Date | 02/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588909642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | KY6807 (Kentucky) | Primary |
Vineland Dental Centre Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Vineland Centre Dr, Suite 17, Vine Grove, KY 40175 Phone: 270-877-2902 Fax: 270-877-2903 |