# WHITE LAVENDER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285462663
- **Authorized official:** DR. MICAH DONLON DMD (FOUNDER)
- **Authorized official phone:** (502) 805-3074

## Contact information

- **Practice address:** 4122 SHELBYVILLE RD STE A, LOUISVILLE, KY 40207-3212
- **Practice address phone:** (502) 805-3074
- **Practice address fax:** (502) 251-0922
- **Mailing address:** 4122 SHELBYVILLE RD STE A, LOUISVILLE, KY 40207-3212
- **Mailing address phone:** (502) 805-3074
- **Mailing address fax:** (502) 251-0922

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223X2210X | Orofacial Pain Dentistry | — | NULL | Yes |
| 1223X2210X | Orofacial Pain Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/25/2024
- **Last updated:** 09/25/2025