| Modern Kids Dentistry Of Louisville, Pllc | |
|
129 Evergreen Rd Louisville KY 40243-2426 | |
| (502) 245-8855 | |
| Not Available |
| Full Name | Modern Kids Dentistry Of Louisville, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 129 Evergreen Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Justin M Raybould (OWNER) |
| Authorized Official Contact | 8593217051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Kids Dentistry Of Louisville, Pllc 129 Evergreen Rd Louisville KY 40243-2426 Ph: (502) 245-8855 | Modern Kids Dentistry Of Louisville, Pllc 129 Evergreen Rd Louisville KY 40243-2426 Ph: (502) 245-8855 |
| NPI Number | 1104646983 |
|---|---|
| Provider Enumeration Date | 10/15/2024 |
| Last Update Date | 10/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104646983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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