Organization
SMILE ST. MATTHEWS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN-MARGARET LUCKETT D.M.D (DENTIST)
(502) 593-4116
Entity
Organization
Contact information
Practice address
114 S SHERRIN AVE, LOUISVILLE, KY 40207-3201
(502) 473-1800
(502) 409-8525
Mailing address
114 S SHERRIN AVE, LOUISVILLE, KY 40207-3201
(502) 473-1800
(502) 409-8525
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8977
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100169580
—
KY
Enumeration date
04/04/2013
Last updated
04/04/2013
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