Individual
JOHN M MCCRILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3935 DUPONT CIR, SUITE C, LOUISVILLE, KY 40207-4824
(502) 458-7476
(502) 458-7797
Mailing address
3935 DUPONT CIR, SUITE C, LOUISVILLE, KY 40207-4824
(502) 458-7476
(502) 458-7797
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4612
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000068357
ANTHEM NON-PAR
KY
Enumeration date
05/19/2006
Last updated
05/17/2016
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