| Kentucky04 | |
|
3438 Taylor Blvd Louisville KY 40215-2648 | |
| (502) 366-4442 | |
| (502) 366-4446 |
| Full Name | Kentucky04 |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3438 Taylor Blvd, Louisville, Kentucky |
| Authorized Official Name and Position | Mandy Holland (CREDENTIALING MANAGER) |
| Authorized Official Contact | 2565043326 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky04 Po Box 2369 Anniston AL 36202-2369 Ph: (256) 241-3965 | Kentucky04 3438 Taylor Blvd Louisville KY 40215-2648 Ph: (502) 366-4442 |
| NPI Number | 1851779888 |
|---|---|
| Provider Enumeration Date | 05/11/2015 |
| Last Update Date | 05/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851779888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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