Provider Demographics
NPI:1881281582
Name:UNION COUNTY FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:UNION COUNTY FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA B
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HANCOCK JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-389-2290
Mailing Address - Street 1:114 N BRADY ST
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-1502
Mailing Address - Country:US
Mailing Address - Phone:270-389-2290
Mailing Address - Fax:270-389-9166
Practice Address - Street 1:114 N BRADY ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1502
Practice Address - Country:US
Practice Address - Phone:270-389-2290
Practice Address - Fax:270-389-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100052080Medicaid