Tds Ky Four, LLC
Clinic/Center, Dental in Louisville, KY. Organization (NPI-2).
NPI number1164065488
StatusActive
Last updated in NPPESNov 27, 2023
Details
- NPI
- 1164065488
- Entity type
- Organization (NPI-2)
- Legal business name
- Tds Ky Four, LLC
- Organization subpart
- No
- Enumeration date
- Oct 18, 2019
- Last updated
- Nov 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
8511 Terry RdLouisville, KY 40258-1751
Phone 812-569-2955
Mailing address
8511 Terry RdLouisville, KY 40258-1751
Authorized official
Adrienne Nicholson
Regional Manager
8125692955
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