Abcdentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8651 Issued in KY

Legal business name

ABCDENTISTRY

Practice address

5316 S 3Rd St
Louisville, KY 40214

Phone

(502) 643-0560

NPI assigned

Mar 28, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Mitisha Martin, DMDNPI 1255592267

Title

Owner

Phone

(502) 276-8778

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Sparkle and Shine Family Dental Doing business as

Locations

Practitioners 1

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

• Mitisha Nichole Martin, DMD

  • Dentist
  • Louisville, KY
  • NPI 1255592267
  NPD Authorized official

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1477058659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5316 S 3RD ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402142612",
            "telephone_number": "502-276-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5316 S 3RD ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40214",
            "telephone_number": "502-643-0560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABCDENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MITISHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-276-8778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "8651",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "KY",
            "license": "8651",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100146420",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sparkle and Shine Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Ann Abbott, MD
• Nicole Abbott
• Paul L Abbott, DMD
• Raymond Abbott
• Sarah Meyer Abbott, PSYD
• Sameh Abdelghani, RPH
• Nourhan Abdelsalam Ahmed, RBT
• Jamil Abdo
• Claudine Abdou
• Saad Nabeel Abdul Karim, M.D.

• All providers in Louisville, KY
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.