Pebble Creek Family Dentistry, P.L.L.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4359 Issued in KY

Legal business name

PEBBLE CREEK FAMILY DENTISTRY, P.L.L.C.

Practice address

2100 N Main St
Madisonville, KY 42431-9007

Phone

(270) 825-2686

Fax

(270) 821-7306

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ronald J. Segebarth, D.D.S.

Title

Owner

Phone

(270) 825-2686

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206489600000",
    "number": "1881737997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 N MAIN ST",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424319007",
            "telephone_number": "270-825-2686",
            "fax_number": "270-821-7306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N MAIN ST",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424319007",
            "telephone_number": "270-825-2686",
            "fax_number": "270-821-7306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEBBLE CREEK FAMILY DENTISTRY, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2008-03-26",
        "status": "A",
        "authorized_official_last_name": "SEGEBARTH",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-825-2686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "4359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; 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.