Organization
PERIOIMPLANT ASSOCIATES, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBBIE L. CLARK (OFFICE MANAGER)
(502) 897-9417
Entity
Organization
Contact information
Practice address
4010 DUPONT CIR, SUITE 524, LOUISVILLE, KY 40207-4812
(502) 897-9417
Mailing address
4010 DUPONT CIR, SUITE 524, LOUISVILLE, KY 40207-4812
(502) 897-9417
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
12011213A
IN
1223P0300X
Periodontics
Primary
4036
KY
1223P0300X
Periodontics
5446
KY
1223P0300X
Periodontics
8228
IN
1223P0300X
Periodontics
8270
IN
1223P0300X
Periodontics
8517
KY
Other
Enumeration date
07/22/2006
Last updated
08/04/2010
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