Organization
GENTLE EXCELLENCE DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS R MCLEAN (MANAGER)
(502) 368-8400
Entity
Organization
Contact information
Practice address
4133 TAYLOR BLVD, LOUISVILLE, KY 40215-2341
(502) 368-8400
(502) 368-8423
Mailing address
4133 TAYLOR BLVD, LOUISVILLE, KY 40215-2341
(502) 368-8400
(502) 368-8423
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45608247
EPSDT
KY
05
—
61943155
—
KY
Enumeration date
10/11/2005
Last updated
05/01/2014
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