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General NPI Number Information
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NPI Number | 1548259377
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Entity Type | Organization
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Legal Business Name | SOUTH LOUISVILLE DENTAL SPECIALISTS INC
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 02/19/2014
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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 | 40214-2152
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Country | US
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Telephone | 502-361-8988
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Fax | 502-361-8230
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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 | 40214-2152
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Country | US
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Telephone | 502-361-8988
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Fax | 502-361-8230
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. ARTHUR L. WICKSON
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Credential | D.M.D.
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Telephone | 502-361-8988
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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 |
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License Number State |
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