Healthcare Provider Details

I. General information

NPI: 1952447633
Provider Name (Legal Business Name): ALLAN D LINEHAN DMD, MS, CDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 BARDSTOWN RD
LOUISVILLE KY
40204-1359
US

IV. Provider business mailing address

1160 BARDSTOWN RD
LOUISVILLE KY
40204-1359
US

V. Phone/Fax

Practice location:
  • Phone: 502-238-3131
  • Fax: 502-238-3181
Mailing address:
  • Phone: 502-238-3131
  • Fax: 502-238-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7835
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: