# UNIVERSITY OF LOUISVILLE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE UNIVERSITY OF LOUISVILLE
- **Other names:** University of Louisville School of Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1861413098
- **Legal business name:** THE UNIVERSITY OF LOUISVILLE
- **Authorized official:** TIMOTHY C DAUGHERTY D.M.D. (ASSOC DEAN FOR CLINICAL AFFAIRS)
- **Authorized official phone:** (502) 852-0982

## Contact information

- **Practice address:** 501 S PRESTON ST, LOUISVILLE, KY 40202-1701
- **Practice address phone:** (502) 852-5096
- **Practice address fax:** (502) 852-1110
- **Mailing address:** 501 S PRESTON ST, LOUISVILLE, KY 40202-1701
- **Mailing address phone:** (502) 852-5128
- **Mailing address fax:** (502) 852-7163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 07/26/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100001450A | — | IN |
| 01 | — | 1048739 | PASSPORT HEALTH PLAN | KY |
| 01 | — | 1049975 | PASSPORT HEALTH PLAN FPP | KY |
| 01 | — | 1151798 | PASSPORT HEALTH PLAN SUHD | KY |
| 05 | — | 61940102 | — | KY |