EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC (NPI# 1972782407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972782407 |
| Entity Type | Organization |
| Organization Name | EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC |
| Practice Address |
300 Middletown Park Pl Ste A Louisville KY 40243-2541 |
| Mailing Address |
1013 N Dupont Sq Ste B Louisville KY 40207-4612 |
| Practice Telephone | 5022543818 |
| Practice Fax Number | 5022543819 |
| Mailing Telephone | 5028975282 |
| Mailing Fax Number | 5028966714 |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2019-12-12 |
| Authorized Official Name | DR. KENNETH WAYNE LIVESAY JR. (ORAL SURGEON) |
| Authorized Official Telephone | 5022543818 |
| Authorized Official Credential | D.M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100122880 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1013 N Dupont Sq Ste B, Louisville, KY 402074612 | 5028975282 | 5028966714 |
| 4181 New Shepherdsville Rd, Bardstown, KY 400049021 | 5023053649 | 5023736562 |
| Street Address |
300 MIDDLETOWN PARK PL STE A |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40243-2541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861534679 | Martin A Segal | Dentist | 300 Middletown Park Pl Ste A, Louisville, KY 40243-2513 | 2007-02-12 |
| 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 | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023510518 | Ralph M. Green Medical Pllc | Dentist | 3809 Poplar Level Rd Ste B, Louisville, KY 40213-1429 | 2018-03-01 |
| 1922361062 | Alan Reisman, Dds, PC | Dentist | 1075 S Boulder Rd Ste 135, Louisville, CO 80027-2559 | 2012-06-22 |
| 1245481175 | Joseph H. Cieslak Dds, Pllc | Dentist | 6501 Dixie Hwy, Louisville, KY 40258-3907 | 2008-10-09 |
| 1033372057 | Lawrence Sivori II | Dentist | 3101 Breckenridge Ln Ste 2d, Louisville, KY 40220-2742 | 2008-07-09 |
| 1790944106 | David Naselsker | Dentist | 3421 Hycliffe Ave, Louisville, KY 40207-3659 | 2008-06-02 |
| 1235329400 | Thad R. Schulten Psc | Dentist | 4515 Churchman Ave., Louisville, KY 40215 | 2007-07-25 |
| 1730382722 | Lewis C. Jones | Dentist | 401 E Chestnut St Unit 550, Louisville, KY 40202-5705 | 2007-06-07 |
| 1104982016 | Mark D. Miller | Dentist | 1211 W Broadway Unit 106, Louisville, KY 40203-2082 | 2006-12-28 |
| 1285709865 | David T Dodd | Dentist | 4122 Shelbyville Rd Ste 120, Louisville, KY 40207-3206 | 2006-11-21 |
| 1306933387 | Alan Jon Reisman | Dentist | 1075 E South Boulder Rd, Suite 230, Louisville, CO 80027-2560 | 2006-10-09 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40243 |
Please comment or provide details below to improve the information on EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC.
| 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.