Organization
UNIVERSITY OF LOUISVILLE
Active
Parent organization
THE UNIVERSITY OF LOUISVILLE
Other names
University of Louisville School of Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE UNIVERSITY OF LOUISVILLE
Authorized official
TIMOTHY C DAUGHERTY D.M.D. (ASSOC DEAN FOR CLINICAL AFFAIRS)
(502) 852-0982
Entity
Organization
Contact information
Practice address
501 S PRESTON ST, LOUISVILLE, KY 40202-1701
(502) 852-5096
(502) 852-1110
Mailing address
501 S PRESTON ST, LOUISVILLE, KY 40202-1701
(502) 852-5128
(502) 852-7163
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001450A
—
IN
01
—
1048739
PASSPORT HEALTH PLAN
KY
01
—
1049975
PASSPORT HEALTH PLAN FPP
KY
01
—
1151798
PASSPORT HEALTH PLAN SUHD
KY
05
—
61940102
—
KY
Enumeration date
07/22/2006
Last updated
07/26/2017
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