MEDICARE: ENGILMAN ORTHODONTICS - SHELBYVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1083888978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENGILMAN ORTHODONTICS - SHELBYVILLE

Provider Business Mailing Address
First Line	:	PO BOX 437169
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40253-7169
Country	:	US
Telephone Number	:	502-633-4613
Fax Number	:	502-633-0048

Provider Business Practice Location Address
First Line	:	1415 MAIN STREET
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8126
Country	:	US
Telephone Number	:	502-633-4613
Fax Number	:	502-633-0048

Authorized Official
Title or Position	:	CFO
Name	:	STEPHEN JAMES
Credential	:
Telephone Number	:	502-254-8504

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	06/16/2014

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Directions to “ENGILMAN ORTHODONTICS - SHELBYVILLE ” Practice Location

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