MEDICARE: DENTAL SURGICENTER OF LOUISVILLE INC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1487043386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SURGICENTER OF LOUISVILLE INC

Provider Business Mailing Address
First Line	:	9709 LAKESIDE BLVD STE 350
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-1216
Country	:	US
Telephone Number	:	713-489-2198
Fax Number	:	713-489-2978

Provider Business Practice Location Address
First Line	:	2800 CANNONS LN
Second Line	:	SUITE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2164
Country	:	US
Telephone Number	:	502-813-8604
Fax Number	:	502-813-8612

Authorized Official
Title or Position	:	CEO
Name	:	DEVIN LARSEN
Credential	:
Telephone Number	:	713-489-2198

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/21/2026

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