Choctaw Brodie Badgett, DMD
Individual provider Active NPI Dentist · Lewisport, KY
NPI 1720204969 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1720204969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- KY. 4697 (KY)
- Practice address
- 8340 U.S. 60 West
Lewisport, KY 42351 - Phone
- (270) 926-1229
- Fax
- (270) 295-3716
- NPI assigned
- Apr 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY. 4697 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | KY. 4697 | KY | Yes |
Addresses
Primary practice location
8340 U.S. 60 West
Lewisport, KY 42351
Mailing address
PO Box 241
Lewisport, KY 42351-0241
Phone (270) 295-3711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60046976 | Medicaid | KY |
Other providers in Lewisport, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.