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501 S Preston St Louisville KY 40202-1701 | |
| (502) 852-5096 | |
| (502) 852-1110 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 501 S Preston St, Louisville, Kentucky |
| Authorized Official Name and Position | Timothy C Daugherty (ASSOC DEAN FOR CLINICAL AFFAIRS) |
| Authorized Official Contact | 5028520982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
501 S Preston St Louisville KY 40202-1701 Ph: (502) 852-5128 | 501 S Preston St Louisville KY 40202-1701 Ph: (502) 852-5096 |
| NPI Number | 1861413098 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 07/26/2017 |
| Medicare PECOS PAC ID | 2264480615 |
|---|---|
| Medicare Enrollment ID | O20050203000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861413098 | NPI | - | NPPES |
| 1151798 | Other | KY | PASSPORT HEALTH PLAN SUHD |
| 61940102 | Medicaid | KY | |
| 100001450A | Medicaid | IN | |
| 1049975 | Other | KY | PASSPORT HEALTH PLAN FPP |
| 1048739 | Other | KY | PASSPORT HEALTH PLAN |
| Provider Name | Brian S Shumway |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1922299387 PECOS PAC ID: 8325120074 Enrollment ID: I20080325000499 |
| Provider Name | William C Scarfe |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598789786 PECOS PAC ID: 8325125578 Enrollment ID: I20080411000432 |
| Provider Name | Zafrulla Khan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1982672150 PECOS PAC ID: 3577640630 Enrollment ID: I20080414000513 |
| Provider Name | Mark L Bernstein |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1659321495 PECOS PAC ID: 2769518919 Enrollment ID: I20101207000722 |
| Provider Name | George M Kushner |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1518917343 PECOS PAC ID: 1850580077 Enrollment ID: I20110104000696 |
| Provider Name | Carmine J Esposito |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1356452874 PECOS PAC ID: 6103008479 Enrollment ID: I20110308000319 |
| Provider Name | Lewis C Jones |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1730382722 PECOS PAC ID: 1850537614 Enrollment ID: I20150717001064 |
| Provider Name | Gerald T Grant |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1699776690 PECOS PAC ID: 6901198175 Enrollment ID: I20160707002582 |
| Provider Name | Robert L Flint |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1093738106 PECOS PAC ID: 9537251384 Enrollment ID: I20170525000705 |
| Provider Name | Suzanne N Barnes |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1902251358 PECOS PAC ID: 7416347844 Enrollment ID: I20211129002195 |
| Provider Name | Maria Leticia Ferreira Cabido |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1740528280 PECOS PAC ID: 8325289341 Enrollment ID: I20230216001711 |
| Provider Name | Sarah Anne Franklin |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1841824604 PECOS PAC ID: 8426428780 Enrollment ID: I20240614001679 |
| Provider Name | Timothy Burnette Naomi |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1861442071 PECOS PAC ID: 5597720060 Enrollment ID: I20241101002544 |
Bardstown Road Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5300 Bardstown Rd, Louisville, KY 40291 Phone: 502-493-0302 | |
Mortenson Family Dental Center - Dixie At Rockford Lane, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4740 Dixie Hwy, Louisville, KY 40216 Phone: 502-447-8992 | |
Tds Ky Five Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 156 Thierman Ln, Louisville, KY 40207 Phone: 502-896-2822 | |
Dental Health Professionals Of Kentucky, P.s.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7704 Bardstown Rd, Louisville, KY 40291 Phone: 502-200-5220 | |
Advanced Dental Center, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8517 Preston Hwy, Louisville, KY 40219 Phone: 502-966-4367 Fax: 502-966-4001 | |
Drs. Graham And Fortune, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9001 Galene Dr, Louisville, KY 40299 Phone: 502-267-8176 Fax: 502-267-8177 |