Healthcare Provider Details

I. General information

NPI: 1417392259
Provider Name (Legal Business Name): LAUREN PARSONS BERRY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. LAUREN NICOLE PARSONS

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9780 ORMSBY STATION RD SUITE 1200
LOUISVIILE KY
40223
US

IV. Provider business mailing address

9780 ORMSBY STATION RD SUITE 1200
LOUISVILLE KY
40223-4049
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-6021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9306
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: