Organization
DHDA HEBRON, PLLC
Active
Parent organization
DHDA PROVIDERCO, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHDA PROVIDERCO, PLLC
Authorized official
PAUL T LAVELLE DMD (CLINICAL DIRECTOR)
(203) 921-6141
Entity
Organization
Contact information
Practice address
1930 PETERSBURG RD, HEBRON, KY 41048-8291
(859) 586-5620
Mailing address
5404 FARM RIDGE LN, PROSPECT, KY 40059-7617
(203) 921-6141
(502) 547-7845
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/16/2021
Last updated
02/16/2021
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