PERIODONTIC & ENDODONTIC SERVICES-JEFFERSON MALL, PLLC (NPI# 1578853982) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578853982 |
| Entity Type | Organization |
| Organization Name | PERIODONTIC & ENDODONTIC SERVICES-JEFFERSON MALL, PLLC |
| Practice Address |
5100 Outer Loop Ste B Louisville KY 40219-4056 |
| Mailing Address |
Po Box 437169 Louisville KY 40253-7169 |
| Practice Telephone | 5029668660 |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |
| Authorized Official Name | STEVE JAMES (CFO) |
| Authorized Official Telephone | 5022548504 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
5100 OUTER LOOP STE B |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40219-4056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799847 | Elizabeth Rouse Wong | Family Medicine | 5100 Outer Loop, Louisville, KY 40219-4056 | 2005-06-08 |
| 1528438124 | Mina Bear | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-4056 | 2015-09-25 |
| 1639585441 | Wanda Lea Schlaug | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-4056 | 2014-07-01 |
| 1467891382 | Marcelo Enrique Venegas | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-3023 | 2013-06-25 |
| 1053756502 | Alexander Musser | Dentist | 5100 Outer Loop, Louisville, KY 40219 | 2013-05-09 |
| 1851620504 | Nancy L Wilding | Registered Nurse | 5100 Outer Loop, Louisville, KY 40219-4056 | 2009-12-09 |
| 1639357502 | Kids Dentistry-jefferson Mall,pllc | Clinic/Center | 5100 Outer Loop, Suite C, Louisville, KY 40219-4056 | 2008-02-04 |
| 1033397914 | Specialized Dental Services-jefferson Mall, Pllc | Dentist | 5100 Outer Loop, Suite B, Louisville, KY 40219-4056 | 2008-02-04 |
| 1174653471 | Charla Jaynette Froman Glover | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-4056 | 2007-03-06 |
| 1437218799 | Ricardo Ferreira Lopez | Family Medicine | 5100 Outer Loop, Louisville, KY 40219-4056 | 2006-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948154 | Kathleen B Berghausen | Nurse Practitioner | 4112 Fern Valley Rod, Louisville, KY 40219 | 2020-09-25 |
| 1174165989 | Joann Deborah Hobbs | Nurse Practitioner | 8216 Delido Rd, Louisville, KY 40219 | 2019-10-14 |
| 1962989319 | Jennifer Lynn Pinkerton | Hearing Instrument Specialist | 7326 Preston Hwy, Suite 206a, Louisville, KY 40219 | 2018-07-27 |
| 1942748447 | Melissa Freeman Emanuele | Speech-Language Pathologist | 1550 Raydale Drive, Lousville, KY 40219 | 2017-02-03 |
| 1083014013 | Christopher Maxey | Specialist/Technologist | Fern Valley Rd, Louisville, KY 40219 | 2014-08-27 |
| 1679985949 | Antwan Turner | Case Manager/Care Coordinator | 5523 Saxon Blvd, Louisville, KY 40219 | 2014-05-21 |
| 1386055168 | Kelly Larson | Case Manager/Care Coordinator | 6809 Bebe Ct., Louisville, KY 40219 | 2014-05-14 |
| 1639414626 | Prettysmilesdenturesandmorellc | Dentist | 19123 West Mcnichols Rd, Detroit, MI 40219 | 2012-12-03 |
| 1881967701 | Vickie Lynn Dixon | Homemaker | 3516 Templewood Dr., Louisville, KY 40219 | 2012-02-23 |
| 1811157555 | Tonya Lynn Frost | Chiropractor | 4300 Outer Loop Ste 10, Louisville, KY 40219 | 2008-06-16 |
| Find all providers in zip 40219 | ||||
| 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 | 40219 |
Please comment or provide details below to improve the information on PERIODONTIC & ENDODONTIC SERVICES-JEFFERSON MALL, 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.