| Louisville Smiles Youth Dentistry, Psc | |
|
3438 Taylor Blvd Louisville KY 40215-2648 | |
| (502) 366-4442 | |
| (502) 366-4446 |
| Full Name | Louisville Smiles Youth Dentistry, Psc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3438 Taylor Blvd, Louisville, Kentucky |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisville Smiles Youth Dentistry, Psc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Louisville Smiles Youth Dentistry, Psc 3438 Taylor Blvd Louisville KY 40215-2648 Ph: (502) 366-4442 |
| NPI Number | 1952528937 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952528937 | NPI | - | NPPES |
| 7100001490 | Medicaid | KY | |
| 200892040A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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