Organization
CANE RUN SMILE CENTER, INC.
Active
Other names
FALLS CITY FAMILY DENTISTRY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSIE J. RILEY DMD (OWNER)
(502) 778-2631
Entity
Organization
Contact information
Practice address
3050 W BROADWAY, LOUISVILLE, KY 40211-1475
(502) 778-2631
(502) 776-3454
Mailing address
3050 W BROADWAY, LOUISVILLE, KY 40211-1475
(502) 778-2631
(502) 776-3454
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5214
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168938
MEDICAID SUBCONTRACTOR #
KY
05
—
61942785
—
KY
Enumeration date
01/24/2007
Last updated
08/22/2020
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