Individual
KENNETH W LIVESAY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1013 N DUPONT SQ STE B, LOUISVILLE, KY 40207-4612
(502) 897-5282
(502) 896-6714
Mailing address
1013 N DUPONT SQ STE B, LOUISVILLE, KY 40207-4612
(502) 897-5282
(502) 966-7148
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8186
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
8186
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64106420
—
KY
Enumeration date
07/01/2006
Last updated
09/17/2019
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