Organization
EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WAYNE LIVESAY JR. D.M.D (ORAL SURGEON)
(502) 254-3818
Entity
Organization
Contact information
Practice address
300 MIDDLETOWN PARK PL STE A, LOUISVILLE, KY 40243-2541
(502) 254-3818
(502) 254-3819
Mailing address
1013 N DUPONT SQ STE B, LOUISVILLE, KY 40207-4612
(502) 897-5282
(502) 896-6714
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100122880
—
KY
Enumeration date
11/01/2007
Last updated
12/12/2019
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