Organization
FAMILY DENTAL ASSOCIATES OF KENTUCKY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL GREGORY BENANTI DMD (OWNER PRES SOLE SHAREHOLDER)
(502) 254-8745
Entity
Organization
Contact information
Practice address
8000 WILLIAM G PENNY LANE, LOUISVILLE, KY 40219
(502) 969-2396
(502) 969-6901
Mailing address
802 KINROSS PLACE, LOUISVILLE, KY 40243
(502) 254-8745
(502) 254-8874
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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