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NPI Code Detail

MEDICARE: DUMESNIL DENTAL

MEDICARE: DUMESNIL DENTAL
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1396733689
Entity Type Code : Organization
Provider Name (Legal Business Name) : DUMESNIL DENTAL
Provider Business Mailing Address
First Line : 2730 DUMESNIL ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40211-3466
Country : US
Telephone Number : 502-778-1900
Fax Number : 502-778-1905
Provider Business Practice Location Address
First Line : 2730 DUMESNIL ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40211-3466
Country : US
Telephone Number : 502-778-1900
Fax Number : 502-778-1905
Authorized Official
Title or Position : OFC MANAGER
Name : MICHELLE FAETH JORDAN
Credential :
Telephone Number : 502-778-1900
Provider Enumeration Date : 10/11/2005
Last Update Date : 08/22/2020

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Directions to “DUMESNIL DENTAL ” Practice Location

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