# LOUISVILLE DENTAL SLEEP MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912354200
- **Authorized official:** DR. JOHN MERTON MCCRILLIS DMD (OWNER)
- **Authorized official phone:** (502) 458-7476

## Contact information

- **Practice address:** 3935 DUPONT CIR, SUITE C, LOUISVILLE, KY 40207-4824
- **Practice address phone:** (502) 458-7476
- **Practice address fax:** (502) 458-7797
- **Mailing address:** 3935 DUPONT CIR, SUITE C, LOUISVILLE, KY 40207-4824
- **Mailing address phone:** (502) 458-7476
- **Mailing address fax:** (502) 458-7797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | KY4612 | KY | Yes |

## Other

- **Enumeration date:** 05/17/2016
- **Last updated:** 05/17/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 610937390 | ANTHEM | KY |