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General NPI Number Information
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NPI Number | 1508015520
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Entity Type | Individual
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Provider Name | ABIGAIL ANN DIERKING DDS
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Gender | Female
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 3002 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40205-3020
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Country | US
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Telephone | 502-451-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 7231 MEADOW RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40218-3780
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Country | US
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Telephone | 317-361-6493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901019890
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011203A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10375
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License Number State | KY
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