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Organization
DHDA PROVIDERCO, PLLC
Active
Organization
DHDA PROVIDERCO, PLLC
Active
Parent organization
DHDA PROVIDERCO, PLLC
Other names
Lavelle Family & Cosmetic Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHDA PROVIDERCO, PLLC
Authorized official
PAUL T LAVELLE DMD (SOLE MEMBER)
(502) 228-0404
Entity
Organization
Contact information
Practice address
13104 W HIGHWAY 42, PROSPECT, KY 40059-9102
(502) 228-0234
Mailing address
13104 W HIGHWAY 42, PROSPECT, KY 40059-9102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/16/2020
Last updated
03/16/2020
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