Organization
SPECIALIZED DENTAL SERVICES-JEFFERSON MALL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY REIBEL (CHIEF FINANCIAL OFFICER)
(502) 254-8526
Entity
Organization
Contact information
Practice address
5100 OUTER LOOP, SUITE B, LOUISVILLE, KY 40219-4056
(502) 410-1702
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
207L00000X
Anesthesiology Physician
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2008
Last updated
08/02/2024
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