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General NPI Number Information
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NPI Number | 1871647438
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Entity Type | Organization
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Legal Business Name | CANE RUN SMILE CENTER, INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 4516 CANE RUN RD
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City | LOUISVILLE
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State | KY
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Zip | 40216-3422
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Country | US
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Telephone | 502-448-1003
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Fax | 502-371-8161
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Provider Business Mailing Address
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Address Line | PO BOX 16866
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City | LOUISVILLE
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State | KY
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Zip | 40256-0866
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Country | US
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Telephone | 502-448-1003
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Fax | 502-371-8161
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSIE J. RILEY
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Credential | DMD
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Telephone | 502-448-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5214
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License Number State | KY
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