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General NPI Number Information
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NPI Number | 1619151180
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Entity Type | Organization
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Legal Business Name | CHILDREN'S SPECIAL CARE DENTISTRY
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 2301 MEADOW DR
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City | LOUISVILLE
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State | KY
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Zip | 40218-1338
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Country | US
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Telephone | 502-451-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 MEADOW DR
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City | LOUISVILLE
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State | KY
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Zip | 40218-1338
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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 | OFFICE MANAGER
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Name | SHANNON MARIE ABANG
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Credential |
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Telephone | 502-451-8900
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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 | 7297
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License Number State | KY
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