# ABCDENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sparkle and Shine Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477058659
- **Authorized official:** DR. MITISHA MARTIN DMD (OWNER)
- **Authorized official phone:** (502) 276-8778

## Contact information

- **Practice address:** 5316 S 3RD ST, LOUISVILLE, KY 40214
- **Practice address phone:** (502) 643-0560
- **Mailing address:** 5316 S 3RD ST, LOUISVILLE, KY 40214-2612
- **Mailing address phone:** (502) 276-8778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8651 | KY | Yes |
| 261QD0000X | Dental Clinic/Center | 8651 | KY | — |

## Other

- **Enumeration date:** 03/28/2018
- **Last updated:** 08/01/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100146420 | — | KY |