NPIMap

Organization Active NPI

Old Louisville Dental Centre

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1225640444
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OLD LOUISVILLE DENTAL CENTRE
Practice address
1504 S 7TH St
Louisville, KY 40208-1711
Phone
(502) 636-5492
Fax
(502) 636-9210
NPI assigned
Aug 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Authorized official

Name
Michelle Elizabeth Faeth
Title
Office Manager
Phone
(502) 718-1226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1504 S 7TH St
Louisville, KY 40208-1711

Mailing address

1504 S 7TH St
Louisville, KY 40208-1711
Phone (502) 636-5492

National Provider Directory

National Provider Directory
Tax ID family
J Mason Associates4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1504 S 7th St
Louisville, KY 40208
Phone (502) 636-5492

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1225640444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 S 7TH ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402081711",
            "telephone_number": "502-636-5492",
            "fax_number": "502-636-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 S 7TH ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402081711",
            "telephone_number": "502-636-5492",
            "fax_number": "502-636-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD LOUISVILLE DENTAL CENTRE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "FAETH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "502-718-1226"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.