# TRIPLE CROWN DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TRIPLE CROWN DENTISTRY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205366846
- **Legal business name:** TRIPLE CROWN DENTISTRY
- **Authorized official:** DR. MARY SHIELDS D.M.D. (OWNER)
- **Authorized official phone:** (502) 409-4299

## Contact information

- **Practice address:** 904 LILY CREEK ROAD, SUITE 101, LOUISVILLE, KY 40243
- **Practice address phone:** (502) 409-4299
- **Practice address fax:** (502) 409-4309
- **Mailing address:** 904 LILY CREEK ROAD, SUITE 101, LOUISVILLE, KY 40243
- **Mailing address phone:** (502) 409-4299
- **Mailing address fax:** (502) 409-4309

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 9076 | KY | Yes |
| 1223G0001X | General Practice Dentistry | 9305 | KY | — |

## Other

- **Enumeration date:** 06/15/2017
- **Last updated:** 06/15/2017