Advanced Dental Center East | |
1901 Rudy Ln Ste 4 Louisville KY 40207-1384 | |
(502) 966-4367 | |
Not Available |
Full Name | Advanced Dental Center East |
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Speciality | Dentist - General Practice |
Location | 1901 Rudy Ln Ste 4, Louisville, Kentucky |
Authorized Official Name and Position | Rachel Talis (PRESIDENT) |
Authorized Official Contact | 5029664367 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Advanced Dental Center East 1901 Rudy Ln Ste 4 Louisville KY 40207-1384 Ph: (502) 966-4367 | Advanced Dental Center East 1901 Rudy Ln Ste 4 Louisville KY 40207-1384 Ph: (502) 966-4367 |
NPI Number | 1922580653 |
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Provider Enumeration Date | 08/29/2018 |
Last Update Date | 06/11/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922580653 | NPI | - | NPPES |
61900353 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 7118 (Kentucky) | Primary |
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