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Organization
CANE RUN SMILE CENTER, INC.
Active
Organization
CANE RUN SMILE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSIE J. RILEY DMD (OWNER)
(502) 448-1003
Entity
Organization
Contact information
Practice address
4516 CANE RUN RD, LOUISVILLE, KY 40216-3422
(502) 448-1003
(502) 371-8161
Mailing address
PO BOX 16866, LOUISVILLE, KY 40256-0866
(502) 448-1003
(502) 371-8161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5214
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168937
MEDICAID SUBCONTRACTOR #
KY
05
—
61942785
—
KY
Enumeration date
01/22/2007
Last updated
02/09/2017
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