NPIMap

Organization Active NPI

Dental Services of Kentucky, PSC

  • Dentist
  • Louisville, KY
National Provider Identifier
1376921098
Registry record updated May 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL SERVICES OF KENTUCKY, PSC
Practice address
3946 Taylorsville Rd.
Louisville, KY 40220
Phone
(502) 276-8950
Fax
(866) 591-0604
NPI assigned
May 14, 2015
Organization subpart
Yes
Parent organization
DENTAL SERVICES OF KENTUCKY, PSCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2017

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

Authorized official

Name
Monica L Long
Title
Manager of Provider Credentialing
Phone
(913) 428-1686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3946 Taylorsville Rd.
Louisville, KY 40220

Mailing address

PO Box 11568
Overland Park, KS 66207
Phone (913) 428-1686

Other identifiers 1

IdentifierTypeStateIssuer
71002245080MedicaidKY

Other names 1

  • Immediadent Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Services of Louisville PSC10 organizations share this tax ID, including this one
Part of
Dental Services of Louisville PSC

Other organizations with this tax ID 9

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

Locations

3946 Taylorsville Rd
Louisville, KY 40220
Phone (502) 276-8950

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1376921098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11568",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "66207",
            "telephone_number": "913-428-1686",
            "fax_number": "866-591-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3946 TAYLORSVILLE RD.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40220",
            "telephone_number": "502-276-8950",
            "fax_number": "866-591-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SERVICES OF KENTUCKY, PSC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL SERVICES OF KENTUCKY, PSC",
        "enumeration_date": "2015-05-14",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MONICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER OF PROVIDER CREDENTIALING",
        "authorized_official_telephone_number": "913-428-1686"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71002245080",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immediadent",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 1, 2017; 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.