| South Louisville Dental Specialists Inc | |
|
4825 S 3rd St Louisville KY 40214-2152 | |
| (502) 361-8988 | |
| (502) 361-8230 |
| Full Name | South Louisville Dental Specialists Inc |
|---|---|
| Speciality | Dentist |
| Location | 4825 S 3rd St, Louisville, Kentucky |
| Authorized Official Name and Position | Arthur L. Wickson (CO-OWNER) |
| Authorized Official Contact | 5023618988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Louisville Dental Specialists Inc 4825 S 3rd St Louisville KY 40214-2152 Ph: (502) 361-8988 | South Louisville Dental Specialists Inc 4825 S 3rd St Louisville KY 40214-2152 Ph: (502) 361-8988 |
| NPI Number | 1548259377 |
|---|---|
| Provider Enumeration Date | 10/14/2005 |
| Last Update Date | 02/19/2014 |
| Medicare PECOS PAC ID | 7012065253 |
|---|---|
| Medicare Enrollment ID | O20090428000373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548259377 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Fred Look |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1396733200 PECOS PAC ID: 6901974203 Enrollment ID: I20081013000588 |
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