Provider Demographics
NPI:1235475112
Name:BIG SANDY DENTAL CENTER PSC
Entity type:Organization
Organization Name:BIG SANDY DENTAL CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-509-8633
Mailing Address - Street 1:180 TOWN MOUNTAIN RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1607
Mailing Address - Country:US
Mailing Address - Phone:606-509-8633
Mailing Address - Fax:606-509-8634
Practice Address - Street 1:180 TOWN MOUNTAIN RD STE 111
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1607
Practice Address - Country:US
Practice Address - Phone:606-509-8633
Practice Address - Fax:606-509-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty