Specialized Dental Services-jefferson Mall, Pllc | |
5100 Outer Loop Suite B Louisville KY 40219-4056 | |
(502) 410-1702 | |
Not Available |
Full Name | Specialized Dental Services-jefferson Mall, Pllc |
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Speciality | Clinic/Center |
Location | 5100 Outer Loop, Louisville, Kentucky |
Authorized Official Name and Position | Jeffrey Reibel (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 5022548526 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Specialized Dental Services-jefferson Mall, Pllc Po Box 437169 Louisville KY 40253-7169 Ph: () - | Specialized Dental Services-jefferson Mall, Pllc 5100 Outer Loop Suite B Louisville KY 40219-4056 Ph: (502) 410-1702 |
NPI Number | 1033397914 |
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Provider Enumeration Date | 02/04/2008 |
Last Update Date | 08/02/2024 |
Medicare PECOS PAC ID | 1759531874 |
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Medicare Enrollment ID | O20121026000414 |
Identifier | Type | State | Issuer |
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1033397914 | NPI | - | NPPES |
Provider Name | Harold T Daniel |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1831136902 PECOS PAC ID: 4385668037 Enrollment ID: I20060120000235 |
Provider Name | Brent W Mortenson |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1356369169 PECOS PAC ID: 7315954187 Enrollment ID: I20060320000475 |
Provider Name | Maneesh Mohan |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1154310985 PECOS PAC ID: 9032354741 Enrollment ID: I20130401000160 |
Provider Name | David A Naselsker |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1790944106 PECOS PAC ID: 1557582202 Enrollment ID: I20180911001606 |
Provider Name | Alexander B Musser |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1053756502 PECOS PAC ID: 1052553708 Enrollment ID: I20180918000810 |
Provider Name | Stephen H Sutley |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1124030085 PECOS PAC ID: 5092815944 Enrollment ID: I20190312001836 |
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