Commonwealth Periodontics & Implant Center

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6224 Issued in KY

Legal business name

COMMONWEALTH PERIODONTICS & IMPLANT CENTER

Practice address

1545 S Main St
London, KY 40741-2071

Phone

(606) 878-1971

Fax

(606) 864-8774

NPI assigned

May 9, 2016

Last updated

May 9, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Krista Paul

Title

Financial Coordinator

Phone

(606) 878-1971

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462752000000",
    "number": "1053767053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 S MAIN ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407412071",
            "telephone_number": "606-878-1971",
            "fax_number": "606-864-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 S MAIN ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407412071",
            "telephone_number": "606-878-1971",
            "fax_number": "606-864-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH PERIODONTICS & IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-05-09",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "606-878-1971"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "KY",
            "license": "6224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in London, KY
• Providers in London, KY by specialty
• Periodontics in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.