Organization
PEDIATRIC DENTAL GROUP OF LOUISVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE ISON (BUSINESS MANAGER)
(502) 327-6380
Entity
Organization
Contact information
Practice address
9710 PARK PLAZA AVE, SUITE 101, LOUISVILLE, KY 40241-2291
(502) 327-6380
(502) 327-8650
Mailing address
9710 PARK PLAZA AVE, SUITE 101, LOUISVILLE, KY 40241-2291
(502) 327-6380
(502) 327-8650
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
03/28/2007
Last updated
08/22/2020
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