Organization · NPI-2

Abcdentistry

Dentist, General Practice · Louisville, KY

NPI number1477058659
StatusActive
Last updated in NPPESAug 1, 2018

Details

NPI
1477058659
Entity type
Organization (NPI-2)
Legal business name
Abcdentistry
Organization subpart
No
Enumeration date
Mar 28, 2018
Last updated
Aug 1, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice8651KYYes
261QD0000X Clinic/Center, Dental8651KY

Other names

  • Sparkle And Shine Family Dental (Doing Business As)

Practice location

5316 S 3rd St
Louisville, KY 40214

Phone 502-643-0560

Mailing address

5316 S 3rd St
Louisville, KY 40214-2612

Phone 502-276-8778

Authorized official

Mitisha Martin
Owner
5022768778

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