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General NPI Number Information
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NPI Number | 1205418258
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Entity Type | Organization
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Legal Business Name | DHDA WFD, LLC
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 3146 N NATIONAL RD
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City | COLUMBUS
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State | IN
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Zip | 47201-3169
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Country | US
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Telephone | 812-372-5568
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Fax |
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Provider Business Mailing Address
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Address Line | 120 WEBSTER ST STE 332
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City | LOUISVILLE
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State | KY
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Zip | 40206-1895
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER OF DHDA PROVIDERCO PLLC
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Name | PAUL LAVELLE
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Credential | DMD
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Telephone | 502-228-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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