MEDICARE: BINKLEY ENDODONTICS, PLLC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1265196653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BINKLEY ENDODONTICS, PLLC

Provider Business Mailing Address
First Line	:	11212 PROFESSIONAL PARK DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4476
Country	:	US
Telephone Number	:	502-742-2168
Fax Number	:

Provider Business Practice Location Address
First Line	:	11212 PROFESSIONAL PARK DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4476
Country	:	US
Telephone Number	:	502-742-2168
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	FAITH GASKINS
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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