Breathitt Dental Clinic PSC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6753 Issued in KY

Legal business name

BREATHITT DENTAL CLINIC PSC

Practice address

221 Highway 15 S
Jackson, KY 41339-9600

Phone

(606) 666-4020

Fax

(606) 666-4021

NPI assigned

Nov 23, 2011

Last updated

Nov 23, 2011By 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

Dr. Roger Campbell

Title

Owner

Phone

(606) 666-4020

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322006400000",
    "number": "1942577697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 854",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417020854",
            "telephone_number": "606-666-4020",
            "fax_number": "606-666-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 HIGHWAY 15 S",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413399600",
            "telephone_number": "606-666-4020",
            "fax_number": "606-666-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREATHITT DENTAL CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-23",
        "last_updated": "2011-11-23",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-666-4020",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "6753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breathitt County Ambulance, Inc.
• Breathitt County Board of Education
• Breathitt County Health Department (Breathitt County Home Health)
• Breathitt County Health Department
• Breathitt County Home Medical LLC
• Breathitt Emergency Group, LLC
• Breathitt-Wolfe EMS Inc
• Breatitt County Geriatric Corporation (nim henson geriatric center)
• Bobby Brewer Jr.
• Carol Bryant Jones, LPCA

• General Practice Dentistry in Jackson, KY
• Providers in Jackson, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; 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.