Modern Kids Dentistry of Louisville, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MODERN KIDS DENTISTRY OF LOUISVILLE, PLLC

Practice address

129 Evergreen Rd
Louisville, KY 40243-2426

Phone

(502) 245-8855

NPI assigned

Oct 15, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Justin M Raybould, DMDNPI 1689817579

Title

Owner

Phone

(859) 321-7051

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Michael Raybould, D.M.D.

  • Pediatric Dentistry
  • Lexington, KY
  • NPI 1689817579
  NPD Authorized official

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

{
    "created_epoch": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1104646983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 EVERGREEN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432426",
            "telephone_number": "502-245-8855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 EVERGREEN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432426",
            "telephone_number": "502-245-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN KIDS DENTISTRY OF LOUISVILLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "RAYBOULD",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-321-7051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Louisville, KY
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.