Healthcare Provider Details

I. General information

NPI: 1659369148
Provider Name (Legal Business Name): JOSEPH DARRELL LYVERS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 TAYLOR BLVD
LOUISVILLE KY
40215-2648
US

IV. Provider business mailing address

9925 MELISSA DR
LOUISVILLE KY
40223-2780
US

V. Phone/Fax

Practice location:
  • Phone: 502-367-0571
  • Fax: 502-366-6821
Mailing address:
  • Phone: 502-429-0665
  • Fax: 502-366-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6045
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: