Healthcare Provider Details

I. General information

NPI: 1316505191
Provider Name (Legal Business Name): BRIAN JANKOWSKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EVERGREEN RD STE 201
LOUISVILLE KY
40243-1486
US

IV. Provider business mailing address

134 EVERGREEN RD STE 201
LOUISVILLE KY
40243-1486
US

V. Phone/Fax

Practice location:
  • Phone: 502-200-5325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number11093
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12014689A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN32423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: