Organization
DHDA WFD, LLC
Active
Parent organization
DHDA PROVIDERCO, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHDA PROVIDERCO, PLLC
Authorized official
PAUL LAVELLE DMD (SOLE MEMBER OF DHDA PROVIDERCO PLLC)
(502) 228-0234
Entity
Organization
Contact information
Practice address
3146 N NATIONAL RD, COLUMBUS, IN 47201-3169
(812) 372-5568
Mailing address
120 WEBSTER ST STE 332, LOUISVILLE, KY 40206-1895
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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