Organization
DENTAL SURGICENTER OF LOUISVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVIN LARSEN (CEO)
(713) 489-2198
Entity
Organization
Contact information
Practice address
2800 CANNONS LN, SUITE 100, LOUISVILLE, KY 40205-2164
(502) 813-8604
(502) 813-8612
Mailing address
9709 LAKESIDE BLVD STE 350, SPRING, TX 77381-1216
(713) 489-2198
(713) 489-2978
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300002398
—
IN
05
—
7100464170
—
KY
Enumeration date
01/15/2015
Last updated
01/30/2026
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