| Cane Run Smile Center, Inc. | |
|
4516 Cane Run Rd Louisville KY 40216-3422 | |
| (502) 448-1003 | |
| (502) 371-8161 |
| Full Name | Cane Run Smile Center, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4516 Cane Run Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Susie J. Riley (OWNER) |
| Authorized Official Contact | 5024481003 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cane Run Smile Center, Inc. Po Box 16866 Louisville KY 40256-0866 Ph: (502) 448-1003 | Cane Run Smile Center, Inc. 4516 Cane Run Rd Louisville KY 40216-3422 Ph: (502) 448-1003 |
| NPI Number | 1871647438 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 02/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871647438 | NPI | - | NPPES |
| 168937 | Other | KY | MEDICAID SUBCONTRACTOR # |
| 61942785 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5214 (Kentucky) | Primary |
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