# DHDA PROVIDERCO, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DHDA PROVIDERCO, PLLC
- **Other names:** Lavelle Family & Cosmetic Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902432537
- **Legal business name:** DHDA PROVIDERCO, PLLC
- **Authorized official:** PAUL T LAVELLE DMD (SOLE MEMBER)
- **Authorized official phone:** (502) 228-0404

## Contact information

- **Practice address:** 13104 W HIGHWAY 42, PROSPECT, KY 40059-9102
- **Practice address phone:** (502) 228-0234
- **Mailing address:** 13104 W HIGHWAY 42, PROSPECT, KY 40059-9102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2020
- **Last updated:** 03/16/2020