Deaton, Kelley 'Corky'

Deaton, Kelley 'Corky' is an sole proprietor health care provider with primary practice located at 359 S 4Th St Suite C, Danville KY 40422-2078. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / General Practice is his primary health care specialty. Deaton, Kelley 'Corky' can be contacted via phone (859) 236-5703.

Contact Information

Primary practice address
359 S 4Th St Suite C Danville KY 40422-2078
Phone: (859) 236-5703
Fax: (859) 936-1916
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 5843 Kentucky
Dental Providers / Dentist 122300000X 5843 Kentucky

Profile Details

NPI number 1851441802
LBN Legal business name Deaton, Kelley 'Corky'
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 11th, 2007
Last updated Mar 11th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851441802 NPPES
Kentucky Other 45601382 EPSDT DENTAL ID
Kentucky Other 61-1180059 EPSDT DENTAL ID
Kentucky MEDICAID 60058435 EPSDT DENTAL ID

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