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General NPI Number Information
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NPI Number | 1861413098
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF LOUISVILLE
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 501 S PRESTON ST
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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 | 502-852-5096
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Fax | 502-852-1110
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Provider Business Mailing Address
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Address Line | 501 S PRESTON ST
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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 | 502-852-5128
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Fax | 502-852-7163
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Authorized Official
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Title or Position | ASSOC DEAN FOR CLINICAL AFFAIRS
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Name | TIMOTHY C DAUGHERTY
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Credential | D.M.D.
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Telephone | 502-852-0982
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #7
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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 |
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Taxonomy #8
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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