Individual
GUSTAVO MACHADO SANTAELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS, PHD
Contact information
Practice address
501 S PRESTON ST, LOUISVILLE, KY 40202-1701
(502) 852-5096
Mailing address
501 S PRESTON ST RM 149M, LOUISVILLE, KY 40202-1701
(502) 852-2585
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10320
KY
Other
Enumeration date
09/12/2019
Last updated
09/12/2019
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