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General NPI Number Information
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NPI Number | 1790584852
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Entity Type | Individual
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Provider Name | LUIZ CARLOS DE LIMA DIAS JR. DDS, M.SC., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 501 S PRESTON ST STE 319
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City | LOUISVILLE
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State | KY
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Zip | 40202-1701
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Country | US
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Telephone | 502-210-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 10508 SHADOW RIDGE LN APT 202
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City | LOUISVILLE
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State | KY
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Zip | 40241-5403
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Country | US
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Telephone | 502-210-7070
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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 | 11250
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License Number State | KY
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