Susan Earnestine Wofford, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

9716 Issued in KY

Practice address

415 Benjamin LN
Louisville, KY 40222-5813

Phone

(502) 423-7868

NPI assigned

Jun 29, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Susan Wofford Himschoot Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mortenson Family Dental Center-Valley Station

  • Dental Clinic/Center
  • Louisville, KY
  • NPI 1427376490
  NPD (past)
• Kenneth G Dale, DDS, LLC

  dba Dale Family Dentistry

  • General Practice Dentistry
  • New Albany, IN
  • NPI 1689049561
  NPD (past)

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1114309986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2241 STATE STREET",
            "address_2": "SUITE C",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "47150",
            "telephone_number": "812-945-5100",
            "fax_number": "502-459-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 BENJAMIN LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225813",
            "telephone_number": "502-423-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOFFORD",
        "first_name": "SUSAN",
        "middle_name": "EARNESTINE",
        "name_prefix": "Mrs.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9716",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013505A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "HIMSCHOOT",
            "middle_name": "WOFFORD",
            "credential": "D.M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Meghan Wnorowski-Bogle, LPAT, ATR-BC
• Elaine M Woerner, MD
• Cheryl Yvette Wofford, MSN,APRN
• Gabriel Wofford, PA
• Jennifer Lene Wofford, PMHNP-BC
• Troy Christopher Wohlgemuth, D.C.
• Teresa Wohlleb, OTR/L
• Haley M Wohner
• Janice Marie Wohrle, MAMFT
• Mallory Woisnet, PHARMD

• Dentist in Louisville, KY
• Providers in Louisville, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.