MEDICARE: SMILE MISSION KENTUCKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1316898059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE MISSION KENTUCKY

Provider Business Mailing Address
First Line	:	3977 7TH STREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4103
Country	:	US
Telephone Number	:	786-358-2420
Fax Number	:	786-386-1457

Provider Business Practice Location Address
First Line	:	3977 7TH STREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4103
Country	:	US
Telephone Number	:	786-358-2420
Fax Number	:	786-386-1457

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DUSTIN PFUNDHELLER
Credential	:	DMD
Telephone Number	:	786-701-8246

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “SMILE MISSION KENTUCKY ” Practice Location

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