SPECIALIZED DENTAL SERVICES.PLLC (NPI# 1316059934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316059934 |
| Entity Type | Organization |
| Organization Name | SPECIALIZED DENTAL SERVICES.PLLC |
| Other Organization Name | KIDS DENTISTREE - MIDDLETOWN |
| Practice Address |
130 Evergreen Rd Louisville KY 40243-1489 |
| Mailing Address |
Po Box 437169 Louisville KY 40253-7169 |
| Practice Telephone | 5024101710 |
| Practice Fax Number | 5022532202 |
| Mailing Telephone | 5022457103 |
| Mailing Fax Number | 5022532202 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-06-28 |
| Authorized Official Name | DR. OWEN WAYNE MORTENSON (GEN DENTIST/OWNER) |
| Authorized Official Telephone | 5022458627 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Kid's Dentistry | Doing Business As Name - Organization |
| Kids Dentistree - Middletown | Doing Business As Name - Organization |
| Street Address |
130 EVERGREEN RD |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40243-1489 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275940819 | Deborah Holladay Counseling, M.s., Lpcc Psc | Community/Behavioral Health | 130 Evergreen Rd, Suite 202, Louisville, KY 40243-1489 | 2014-07-15 |
| 1457479818 | Kelly Ann Underwood | Dentist | 130 Evergreen Rd, Suite 100, Louisville, KY 40243-1489 | 2007-03-26 |
| 1346333911 | Deborah Lee Holladay | Counselor | 130 Evergreen Rd, Suite 202, Louisville, KY 40243-1489 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801949 | Pulsemer Health LLC | Clinic/Center | 11408 Shelbyville Rd, Suite 2, Louisville, KY 40243 | 2020-11-05 |
| 1316563372 | Molly Elizabeth Fitzgerald | Counselor | 350 Evergreen Road Suite 102, Louisville, KY 40243 | 2020-06-24 |
| 1215575410 | Eric Wolfe | Pharmacist | 1320 Snake Foot Drive, Apt 204, Louisville, KY 40243 | 2019-12-18 |
| 1417501974 | Joshua Bynum | Physical Therapist | 12935 Shelbyville Road Ste 106, Louisville, KY 40243 | 2019-08-01 |
| 1376013342 | Carmen Sue Frederick | Psychologist | 731 Speckman Road, Louisville, KY 40243 | 2018-12-03 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1659811636 | Jean Steltenpohl | Dietitian, Registered | 518 Cheskirk Pl, Louisville, KY 40243 | 2017-02-24 |
| 1548555287 | Jonathan D Senters | Pharmacist | 12975 Shelbyville Road, T-2728, Middletown, KY 40243 | 2011-06-10 |
| 1023339835 | Ashley Rose Havens | Speech-Language Pathologist | 11510 Main Street, Louisville, KY 40243 | 2010-06-15 |
| 1801110424 | Shawna L. Kauffman | Family Medicine | 12955 Shelbyville Rd Ste 2, Louisville, KY 40243 | 2010-03-25 |
| Find all providers in zip 40243 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114530748 | Sol Dental Pllc | Clinic/Center | 1371 Hecla Dr Ste D2, Louisville, CO 80027-2318 | 2020-08-24 |
| 1144838970 | Superior Smiles, LLC | Clinic/Center | 16690 E Main St, Louisville, MS 39339-2750 | 2020-07-17 |
| 1629696505 | Kauffmann and Sims Dentistry Pllc | Clinic/Center | 3935 Dupont Cir Ste A, Louisville, KY 40207-4824 | 2020-07-08 |
| 1699394783 | Professional Dental Services of Kentucky Psc | Clinic/Center | 4814 Outer Loop Ste A, Louisville, KY 40219-3302 | 2020-04-09 |
| 1316579279 | Shannon P Johnson Dmd Pllc | Clinic/Center | 9510 Ormsby Station Rd Ste 203, Louisville, KY 40223-4083 | 2020-02-09 |
| 1306306253 | Tds Ky Two | Clinic/Center | 5141 Dixie Hwy Ste 101, Louisville, KY 40216-1765 | 2019-03-25 |
| 1669937058 | Hometown Family Dental | Clinic/Center | 4122 Shelbyville Rd Ste C, Louisville, KY 40207-3212 | 2019-02-10 |
| 1447714944 | Cobalt Dental Care, LLC | Clinic/Center | 225 S Hurstbourne Pkwy Ste 102, Louisville, KY 40222-4929 | 2019-01-29 |
| 1285129882 | Combs Family Dentistry | Clinic/Center | 2300 Terra Crossing Blvd Ste 108, Louisville, KY 40245-5906 | 2018-06-26 |
| 1972097277 | D & D Dental Enterprises | Clinic/Center | 6790 Dixie Hwy, Louisville, KY 40258 | 2018-06-20 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40243 |
Please comment or provide details below to improve the information on SPECIALIZED DENTAL SERVICES.PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.