Organization
MATTINGLY ORTHODONTICS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS L MATTINGLY DMD (VICE PRESIDENT)
(502) 895-3473
Entity
Organization
Contact information
Practice address
1013 DUPONT SQ N, LOUISVILLE, KY 40207-4612
(502) 895-3473
(502) 897-3795
Mailing address
1013 DUPONT SQ N, LOUISVILLE, KY 40207-4612
(502) 895-3473
(502) 897-3795
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7289
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60063435
—
KY
Enumeration date
11/30/2005
Last updated
03/06/2008
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