Organization
MODERN KIDS DENTISTRY OF LOUISVILLE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN M RAYBOULD DMD (OWNER)
(859) 321-7051
Entity
Organization
Contact information
Practice address
129 EVERGREEN RD, LOUISVILLE, KY 40243-2426
(502) 245-8855
Mailing address
129 EVERGREEN RD, LOUISVILLE, KY 40243-2426
(502) 245-8855
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
10/15/2024
Last updated
10/15/2024
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