| Periodontic & Endodontic Services-jefferson Mall, Pllc | |
|
5100 Outer Loop Ste B Louisville KY 40219-4056 | |
| (502) 966-8660 | |
| Not Available |
| Full Name | Periodontic & Endodontic Services-jefferson Mall, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5100 Outer Loop, Louisville, Kentucky |
| Authorized Official Name and Position | Steve James (CFO) |
| Authorized Official Contact | 5022548504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontic & Endodontic Services-jefferson Mall, Pllc Po Box 437169 Louisville KY 40253-7169 Ph: () - | Periodontic & Endodontic Services-jefferson Mall, Pllc 5100 Outer Loop Ste B Louisville KY 40219-4056 Ph: (502) 966-8660 |
| NPI Number | 1578853982 |
|---|---|
| Provider Enumeration Date | 04/19/2011 |
| Last Update Date | 04/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578853982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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