Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5355 | KY |
NPI | 1003220526 |
---|---|
Provider Name | Dr. Richard Allen Jeter |
First Address | Campbellsville, KY 42718-9618 |
Second Address | Campbellsville, KY 42718-9618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 12/06/2014 |