MEDICARE: DR. GILLIAN ELISE CASEY DMD, MSD

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	122300000X	Dentist	12014069A	IN
2	1223P0221X	Pediatric Dentistry	1239	KY

General Provider Information

NPI Number	:	1164114047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILLIAN ELISE CASEY DMD, MSD

Provider Business Mailing Address
First Line	:	3709 HURSTBOURNE RIDGE BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-6507
Country	:	US
Telephone Number	:	859-613-2481
Fax Number	:

Provider Business Practice Location Address
First Line	:	8727 OLD BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4490
Country	:	US
Telephone Number	:	502-200-1173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	07/12/2025

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