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General NPI Number Information
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NPI Number | 1942932694
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Entity Type | Organization
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Legal Business Name | ALJUKIC PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 9710 PARK PLAZA AVE UNIT 101
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City | LOUISVILLE
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State | KY
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Zip | 40241-2292
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Country | US
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Telephone | 502-327-6380
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Fax | 502-327-8650
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Provider Business Mailing Address
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Address Line | 9710 PARK PLAZA AVE UNIT 101
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City | LOUISVILLE
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State | KY
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Zip | 40241-2292
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Country | US
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Telephone | 502-327-6380
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Fax | 502-327-8650
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. REGINA KURTZ
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Credential |
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Telephone | 502-327-6380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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