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General NPI Number Information
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NPI Number | 1538627930
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Entity Type | Organization
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Legal Business Name | BEECHMONT FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 4825 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40214-2184
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Country | US
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Telephone | 502-366-6362
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Fax | 502-368-8600
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Provider Business Mailing Address
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Address Line | 4825 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40214-2184
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Country | US
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Telephone | 502-366-6362
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Fax | 502-368-8600
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MORGAN MENARD
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Credential | DMD
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Telephone | 502-366-6362
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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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