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General NPI Number Information
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NPI Number | 1720404478
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Entity Type | Organization
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Legal Business Name | LOUISA DENTAL CARE
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 203 S. WATER ST
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-4689
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Fax | 606-483-8005
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Provider Business Mailing Address
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Address Line | 203 S. WATER ST P.O. BOX 70
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-4689
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Fax | 606-483-8005
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY LEWIS MEADE
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Credential | DMD
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Telephone | 606-638-4689
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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 | 6690
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6598
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License Number State | KY
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