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Organization

LOUISVILLE DENTAL SLEEP MEDICINE PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN MERTON MCCRILLIS DMD (OWNER)
(502) 458-7476
Entity
Organization

Contact information

Practice address
3935 DUPONT CIR, SUITE C, LOUISVILLE, KY 40207-4824
(502) 458-7476
(502) 458-7797
Mailing address
3935 DUPONT CIR, SUITE C, LOUISVILLE, KY 40207-4824
(502) 458-7476
(502) 458-7797

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
KY4612
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
610937390
TRICARE
KY
Enumeration date
05/17/2016
Last updated
05/17/2016
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