Specialized Dental Services-Jefferson Mall, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SPECIALIZED DENTAL SERVICES-JEFFERSON MALL, PLLC

Practice address

5100 Outer Loop
Suite B
Louisville, KY 40219-4056

Phone

(502) 410-1702

NPI assigned

Feb 4, 2008

Last updated

Aug 2, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey Reibel

Title

Chief Financial Officer

Phone

(502) 254-8526

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Britt D Bostick, D.D.S.

  • Dentist
  • Lubbock, TX
  • NPI 1295881027
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1033397914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437169",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402537169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 OUTER LOOP",
            "address_2": "SUITE B",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402194056",
            "telephone_number": "502-410-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALIZED DENTAL SERVICES-JEFFERSON MALL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "REIBEL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "502-254-8526"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialty Orthopaedics PSC
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• Specialty Orthopaedics, PSC

• Dental Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Dental Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.