MEDICARE: PAMELA J ASSEFF, DDS, PSC

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	6806	KY

General Provider Information

NPI Number	:	1811398837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA J ASSEFF, DDS, PSC

Provider Business Mailing 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

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	:	OWNER/DENTIST
Name	:	DR. PAMELA JEAN ASSEFF
Credential	:	DDS
Telephone Number	:	502-493-4154

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	09/09/2014

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