# EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1972782407
- **Authorized official:** DR. KENNETH WAYNE LIVESAY JR. D.M.D (ORAL SURGEON)
- **Authorized official phone:** (502) 254-3818

## Contact information

- **Practice address:** 300 MIDDLETOWN PARK PL STE A, LOUISVILLE, KY 40243-2541
- **Practice address phone:** (502) 254-3818
- **Practice address fax:** (502) 254-3819
- **Mailing address:** 1013 N DUPONT SQ STE B, LOUISVILLE, KY 40207-4612
- **Mailing address phone:** (502) 897-5282
- **Mailing address fax:** (502) 896-6714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 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