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299 West Lincoln Trail Blvd Suite 102 Radcliff KY 40160 | |
| (270) 352-5566 | |
| (270) 352-5602 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 299 West Lincoln Trail Blvd, Radcliff, Kentucky |
| Authorized Official Name and Position | Angela R Shelton (DENTIST OWNER) |
| Authorized Official Contact | 2703525566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 778 Radcliff KY 40159-0778 Ph: (270) 352-5566 | 299 West Lincoln Trail Blvd Suite 102 Radcliff KY 40160 Ph: (270) 352-5566 |
| NPI Number | 1427151059 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 07/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427151059 | NPI | - | NPPES |
| 551702 | Other | KY | UNITED CONCORDIA TRICARE |
| 6000338 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7521 (Kentucky) | Primary |
Susan M. King, D.m.d. And Associates, P.s.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 555 W Lincoln Trail Blvd, Suite 43, Radcliff, KY 40160 Phone: 270-351-6201 Fax: 270-351-6276 | |
Ernest O. Skaggs Dmd,psc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 555 W Lincoln Trail Blvd, Suite 25, Radcliff, KY 40160 Phone: 270-351-3265 Fax: 270-351-3557 |