Organization
CANE RUN SMILE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSIE J. RILEY DMD (OWNER)
(502) 448-1003
Entity
Organization
Contact information
Practice address
4516 CANE RUN RD, LOUISVILLE, KY 40216-3422
(502) 448-1003
(502) 371-8161
Mailing address
PO BOX 16866, LOUISVILLE, KY 40256-0866
(502) 448-1003
(502) 371-8161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5214
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168937
MEDICAID SUBCONTRACTOR #
KY
05
—
61942785
—
KY
Enumeration date
01/22/2007
Last updated
02/09/2017
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