Healthcare Provider Details

I. General information

NPI: 1962028829
Provider Name (Legal Business Name): KNOBS DAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 US-150 #9
FLOYDS KNOBS IN
47119
US

IV. Provider business mailing address

3002 BARDSTOWN ROAD
LOUISVILLE KY
40205
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-1400
  • Fax: 812-923-8510
Mailing address:
  • Phone: 502-451-2212
  • Fax: 502-456-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDSEY NICHOLE GRAVES
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 502-451-2212