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Organization
ABCDENTISTRY
Active
Organization
ABCDENTISTRY
Active
Other names
Sparkle and Shine Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITISHA MARTIN DMD (OWNER)
(502) 276-8778
Entity
Organization
Contact information
Practice address
5316 S 3RD ST, LOUISVILLE, KY 40214
(502) 643-0560
Mailing address
5316 S 3RD ST, LOUISVILLE, KY 40214-2612
(502) 276-8778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8651
KY
261QD0000X
Dental Clinic/Center
8651
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100146420
—
KY
Enumeration date
03/28/2018
Last updated
08/01/2018
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