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Organization
EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC
Active
Organization
EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WAYNE LIVESAY JR. D.M.D (ORAL SURGEON)
(502) 254-3818
Entity
Organization
Contact information
Practice address
300 MIDDLETOWN PARK PL STE A, LOUISVILLE, KY 40243-2541
(502) 254-3818
(502) 254-3819
Mailing address
1013 N DUPONT SQ STE B, LOUISVILLE, KY 40207-4612
(502) 897-5282
(502) 896-6714
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Enumeration date
11/01/2007
Last updated
12/12/2019
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