Individual
DR. MATTHEW ALAN BORMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
501 TAYLORSVILLE RD., TAYLORSVILLE, KY 40071
(502) 477-2248
Mailing address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9008
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100195400
—
KY
Enumeration date
06/22/2011
Last updated
06/24/2019
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