Provider Demographics
NPI:1548336985
Name:W BRUCE COMBEST PSC
Entity type:Organization
Organization Name:W BRUCE COMBEST PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:COMBEST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-986-4661
Mailing Address - Street 1:402 RICHMOND RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403
Mailing Address - Country:US
Mailing Address - Phone:859-986-4661
Mailing Address - Fax:859-986-3579
Practice Address - Street 1:402 RICHMOND RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403
Practice Address - Country:US
Practice Address - Phone:859-986-4661
Practice Address - Fax:859-986-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY615124Q00000X
KY45731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty