Organization
TDS KY TWO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE NICHOLSON (REGIONAL MANAGER)
(812) 569-2955
Entity
Organization
Contact information
Practice address
5141 DIXIE HWY STE 101, LOUISVILLE, KY 40216-1765
(502) 449-2733
Mailing address
5141 DIXIE HWY STE 101, LOUISVILLE, KY 40216-1765
(502) 449-2733
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/25/2019
Last updated
06/10/2020
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