Organization
BLYSTONE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AILEY BLYSTONE DDS (PRACTICE OWNER)
(270) 234-7624
Entity
Organization
Contact information
Practice address
642 BAXTER AVE STE 110, LOUISVILLE, KY 40204-1795
(502) 208-9385
Mailing address
102 KENTUCKY OAKS TRL, ELIZABETHTOWN, KY 42701-4483
(270) 234-7624
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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