Healthcare Provider Details

I. General information

NPI: 1164387700
Provider Name (Legal Business Name): SMILE SHELBYVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WASHINGTON ST
SHELBYVILLE KY
40065-1430
US

IV. Provider business mailing address

1100 WASHINGTON ST
SHELBYVILLE KY
40065-1430
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1915
  • Fax:
Mailing address:
  • Phone: 502-633-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA D BURTON
Title or Position: DENTIST
Credential: DMD
Phone: 502-633-1915