Organization
LOUISVILLE SMILES YOUTH DENTISTRY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (MANAGER, LICENSING & CREDENTIALING)
(615) 750-0343
Entity
Organization
Contact information
Practice address
3438 TAYLOR BLVD, LOUISVILLE, KY 40215-2648
(502) 366-4442
(502) 366-4446
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200892040A
—
IN
05
—
7100001490
—
KY
Enumeration date
04/19/2007
Last updated
07/09/2014
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