NPIMap

Organization Active NPI

Dental Surgicenter of Louisville LLC

  • Ambulatory Surgical Clinic/Center
  • Louisville, KY
National Provider Identifier
1487043386
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
DENTAL SURGICENTER OF LOUISVILLE LLC
Practice address
2800 Cannons LN
Suite 100
Louisville, KY 40205-2164
Phone
(502) 813-8604
Fax
(502) 813-8612
NPI assigned
Jan 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Authorized official

Name
Devin Larsen
Title
Ceo
Phone
(713) 489-2198

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

2800 Cannons LN
Suite 100
Louisville, KY 40205-2164

Mailing address

9709 Lakeside Blvd Ste 350
Spring, TX 77381-1216
Phone (713) 489-2198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160902000256 KY Part B Supplier - Ambulatory Surgical Center 9830485606 Practice locations: Louisville, KY

Ambulatory surgical center certification: CCN 18C0001047

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Dental Surgicenter of Louisville, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Feb 10, 2017
Last certification
Mar 5, 2020
Ownership / control type
Proprietary
Facility address
2800 Cannons Lane, Suite 100
Louisville, KY 40205

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dental Surgicenter of Louisville2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769731200000",
    "number": "1487043386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 LAKESIDE BLVD STE 350",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773811216",
            "telephone_number": "713-489-2198",
            "fax_number": "713-489-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 CANNONS LN",
            "address_2": "SUITE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052164",
            "telephone_number": "502-813-8604",
            "fax_number": "502-813-8612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SURGICENTER OF LOUISVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "713-489-2198"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.