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General NPI Number Information
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NPI Number | 1649271263
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Entity Type | Organization
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Legal Business Name | GREATER LOUISVILLE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PSC
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3101 BRECKENRIDGE LN STE 2D
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City | LOUISVILLE
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State | KY
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Zip | 40220-2742
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Country | US
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Telephone | 502-459-8012
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Fax | 502-459-8021
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Provider Business Mailing Address
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Address Line | 3101 BRECKENRIDGE LN STE 2D
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City | LOUISVILLE
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State | KY
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Zip | 40220-2742
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Country | US
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Telephone | 502-459-8012
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Fax | 502-459-8021
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DEBBIE J TROKLUS
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Credential |
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Telephone | 502-459-9973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | KY
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