Organization
TDS KY FOUR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE NICHOLSON (REGIONAL MANAGER)
(812) 569-2955
Entity
Organization
Contact information
Practice address
8511 TERRY RD, LOUISVILLE, KY 40258-1751
(812) 569-2955
Mailing address
8511 TERRY RD, LOUISVILLE, KY 40258-1751
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2019
Last updated
11/27/2023
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