MEDICARE: DR. PAMELA JEAN ASSEFF DDS

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	1223G0001X	General Practice Dentistry	6806	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306834460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA JEAN ASSEFF DDS

Provider Business Mailing Address
First Line	:	3101 SHADY SPRINGS DR
Second Line	:
City	:	JEFFERSONTOWN
State	:	KY
Zip	:	40299-4573
Country	:	US
Telephone Number	:	502-267-8342
Fax Number	:

Provider Business Practice Location Address
First Line	:	3046 BRECKENRIDGE LN
Second Line	:	SUITE 101
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2190
Country	:	US
Telephone Number	:	502-493-4154
Fax Number	:	502-491-0695

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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