| Portland Dental Center And Broadway Dental | |
|
465 N 26th St Louisville KY 40212-1449 | |
| (502) 778-7767 | |
| (502) 778-7677 |
| Full Name | Portland Dental Center And Broadway Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 465 N 26th St, Louisville, Kentucky |
| Authorized Official Name and Position | Hugo Pavon (PRESIDENT) |
| Authorized Official Contact | 5023260789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Dental Center And Broadway Dental 3600 Glenfield Ct Louisville KY 40241-2513 Ph: (502) 326-0789 | Portland Dental Center And Broadway Dental 465 N 26th St Louisville KY 40212-1449 Ph: (502) 778-7767 |
| NPI Number | 1073833059 |
|---|---|
| Provider Enumeration Date | 06/01/2010 |
| Last Update Date | 06/01/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073833059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6711 (Kentucky) | Primary |
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