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General NPI Number Information
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NPI Number | 1568021657
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Entity Type | Individual
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Provider Name | MAKENNA HELENE WILLIAMS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 3946 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40220-1450
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Country | US
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Telephone | 502-276-8950
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MELLWOOD AVE APT 1318
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City | LOUISVILLE
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State | KY
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Zip | 40206-1075
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Country | US
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Telephone | 410-703-7408
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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 | 10257
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License Number State | KY
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