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General NPI Number Information
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NPI Number | 1710679105
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Entity Type | Organization
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Legal Business Name | BLUEGRASS DENTAL ANESTHESIA, LLC
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 3001 HAYFIELD DR
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City | LOUISVILLE
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State | KY
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Zip | 40205-2809
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Country | US
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Telephone | 408-314-4968
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 HAYFIELD DR
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City | LOUISVILLE
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State | KY
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Zip | 40205-2809
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Country | US
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Telephone | 408-314-4968
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Fax |
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Authorized Official
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Title or Position | MANAGER/ DENTIST ANESTHESIOLOGIST
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Name | DR. DAVID GUTHRIE
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Credential | DMD
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Telephone | 408-314-4968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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