COMMONWEALTH PERIODONTICS & IMPLANT CENTER (NPI# 1053767053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053767053 |
| Entity Type | Organization |
| Organization Name | COMMONWEALTH PERIODONTICS & IMPLANT CENTER |
| Practice Address |
1545 S Main St London KY 40741-2071 |
| Practice Telephone | 6068781971 |
| Practice Fax Number | 6068648774 |
| Mailing Telephone | 6068781971 |
| Mailing Fax Number | 6068648774 |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2016-05-09 |
| Authorized Official Name | KRISTA PAUL (FINANCIAL COORDINATOR) |
| Authorized Official Telephone | 6068781971 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
6224 | KY | Dental Providers |
| Street Address |
1545 S MAIN ST |
| City | LONDON |
| State | KY |
| Zip Code | 40741-2071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346841244 | Emily Anne Simmons | Pharmacist | 1851 West Hwy 192, London, KY 40741 | 2020-11-06 |
| 1871104364 | Jarrod Lee Napier | Optometrist | 103 Chera Lyn Ln, London, KY 40741 | 2020-08-10 |
| 1295378792 | Rebekah Virginia Elaine Cloud | Nurse Practitioner | 1649 Ky- 192 W, London, KY 40741 | 2019-10-28 |
| 1215416581 | Mary Jean Nolan | Nurse Practitioner | 1649 W. Hwy 192, London, KY 40741 | 2018-08-08 |
| 1558849620 | Pinnacle Treatment Centers Ky-1, LLC | Substance Abuse Rehabilitation Facility | 312 Carrera Drive, London, KY 40741 | 2018-08-01 |
| 1710463435 | Pinnacle Treatment Centers Ky-i, LLC | Substance Abuse Rehabilitation Facility | 300 Carrera Drive, London, KY 40741 | 2018-07-16 |
| 1720591076 | Hillary Clark | Nurse Practitioner | 192 London Shopping Ctr Ste 2, London, KY 40741 | 2017-11-08 |
| 1760901979 | Ariel Siler | Counselor | 454 N. Mcwhorter St., Suite 1, London, KY 40741 | 2017-09-19 |
| 1598287161 | Young Smiles,llc | Clinic/Center | 324 Holly Lane, London, KY 40741 | 2017-07-14 |
| 1952727505 | Renew Recovery, LLC | Substance Abuse Rehabilitation Facility | 2645 N Laurel Rd Ste B, London, KY 40741 | 2014-03-06 |
| Find all providers in zip 40741 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104440874 | Greg L Adams Dmd Ms Psc | Dentist | 2880 Farrell Cres, Owensboro, KY 42303-1392 | 2020-05-29 |
| 1811462336 | Lexington Periodontics and Implant Dentistry | Dentist | 620 Perimeter Dr Ste 201, Lexington, KY 40517-4125 | 2018-10-11 |
| 1447789029 | John Andrew Houston | Dentist | 5141 Dixie Hwy Ste 102, Louisville, KY 40216-1765 | 2017-06-07 |
| 1033573415 | Jodie Lusby | Dentist | 4010 Dupont Cir Ste 524, St Matthews, KY 40207-4888 | 2016-04-11 |
| 1316272198 | Mark Allen King | Dentist | 107 Frazier Court, Suite 1d, Georgetown, KY 40324-8973 | 2009-10-12 |
| 1326285883 | Jeff Dickson | Dentist | 249 Greenbriar Rd, Lexington, KY 40503-4020 | 2009-01-20 |
| 1609013481 | Amjad Aldallal | Dentist | 3900 Crosby Dr Apt 2212, Lexington, KY 40515-1808 | 2009-01-15 |
| 1790977668 | Ward Thomas Piepgrass | Dentist | 3181 Beaumont Centre Cir, Lexington, KY 40513-1836 | 2007-08-15 |
| 1972714756 | Homing Kim | Dentist | 938 Louisville Rd, 200, Frankfort, KY 40601 | 2007-05-24 |
| 1710191317 | Carl N. Bauman | Dentist | 10228 Shelbyville Rd, Louisville, KY 40223-2978 | 2007-05-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.