Main Street Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

KY6807 Issued in KY

Legal business name

MAIN STREET DENTAL, LLC

Practice address

201 W Main St
Vine Grove, KY 40175-1304

Phone

(270) 877-2011

NPI assigned

Nov 30, 2012

Last updated

Feb 12, 2014By 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

Mr. Jeffrey L Corkran

Title

GM/Owner

Phone

(270) 877-2011

Specialties & licenses 1

Addresses

Other names 1

• Main Street Dental, LLC Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christian Michael Bennett, DMD

  • General Practice Dentistry
  • Vine Grove, KY
  • NPI 1982220992
  NPD (past)
• Theresa D Kenna, D.M.D.

  • General Practice Dentistry
  • Vine Grove, KY
  • NPI 1982806592
  NPD (past)

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

{
    "created_epoch": "1354233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392163200000",
    "number": "1588909642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W MAIN ST",
            "city": "VINE GROVE",
            "state": "KY",
            "postal_code": "401751304",
            "telephone_number": "270-877-2011",
            "fax_number": "270-877-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W MAIN ST",
            "city": "VINE GROVE",
            "state": "KY",
            "postal_code": "401751304",
            "telephone_number": "270-877-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-30",
        "last_updated": "2014-02-12",
        "status": "A",
        "authorized_official_last_name": "CORKRAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "GM/OWNER",
        "authorized_official_telephone_number": "270-877-2011",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "KY",
            "license": "KY6807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Dental, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Theresa D Kenna, D.M.D.
• Brenda Doreen King, 01/01/2011
• Tatjana Gabrielle Lauterbach, LCSW
• Jessi Diana Lloyd, NP-C
• Shayna Jane Luttrell, M.S. CCC SLP
• Markins PSC
• Bridget Louise Marnell, ATC
• Indira A Montenegro
• Alexa Noel Murphy, RBT-23-260503
• Toya S Northington

• Dental Clinic/Center in Vine Grove, KY
• Providers in Vine Grove, KY by specialty
• Dental Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2014; 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.