| Blystone Dental Pllc | |
|
642 Baxter Ave Ste 110 Louisville KY 40204-1795 | |
| (502) 208-9385 | |
| Not Available |
| Full Name | Blystone Dental Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 642 Baxter Ave Ste 110, Louisville, Kentucky |
| Authorized Official Name and Position | Ailey Blystone (PRACTICE OWNER) |
| Authorized Official Contact | 2702347624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blystone Dental Pllc 102 Kentucky Oaks Trl Elizabethtown KY 42701-4483 Ph: (270) 234-7624 | Blystone Dental Pllc 642 Baxter Ave Ste 110 Louisville KY 40204-1795 Ph: (502) 208-9385 |
| NPI Number | 1104675875 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104675875 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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