# CANE RUN SMILE CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FALLS CITY FAMILY DENTISTRY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649325457
- **Authorized official:** DR. SUSIE J. RILEY DMD (OWNER)
- **Authorized official phone:** (502) 778-2631

## Contact information

- **Practice address:** 3050 W BROADWAY, LOUISVILLE, KY 40211-1475
- **Practice address phone:** (502) 778-2631
- **Practice address fax:** (502) 776-3454
- **Mailing address:** 3050 W BROADWAY, LOUISVILLE, KY 40211-1475
- **Mailing address phone:** (502) 778-2631
- **Mailing address fax:** (502) 776-3454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5214 | KY | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 168938 | MEDICAID SUBCONTRACTOR \# | KY |
| 05 | — | 61942785 | — | KY |