Healthcare Provider Details

I. General information

NPI: 1205081247
Provider Name (Legal Business Name): SURE-FIT DENTURES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 DIXIE HWY.
LOUISVILLE KY
40216
US

IV. Provider business mailing address

4115 DIXIE HWY.
LOUISVILLE KY
40216-3811
US

V. Phone/Fax

Practice location:
  • Phone: 502-448-5050
  • Fax: 502-449-4115
Mailing address:
  • Phone: 502-448-5050
  • Fax: 502-449-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: DARLENE HAUNER
Title or Position: OWNER
Credential:
Phone: 502-448-5050