NPIMap

Organization Active NPI

Cane Run Smile Center, Inc.

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1871647438
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5214 Issued in KY
Legal business name
CANE RUN SMILE CENTER, INC.
Practice address
4516 Cane Run Rd
Louisville, KY 40216-3422
Phone
(502) 448-1003
Fax
(502) 371-8161
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Dr. Susie J. Riley, DMD
Title
Owner
Phone
(502) 448-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5214 KY Primary

Addresses

Primary practice location

4516 Cane Run Rd
Louisville, KY 40216-3422

Mailing address

PO Box 16866
Louisville, KY 40256-0866
Phone (502) 448-1003

Other identifiers 2

IdentifierTypeStateIssuer
168937OtherKYMEDICAID SUBCONTRACTOR #
61942785MedicaidKY

National Provider Directory

National Provider Directory

Locations

4516 Cane Run Rd
Louisville, KY 40216
Phone (502) 448-1003

Practitioners & affiliated clinicians

Practitioners 3

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1871647438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16866",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402560866",
            "telephone_number": "502-448-1003",
            "fax_number": "502-371-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 CANE RUN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402163422",
            "telephone_number": "502-448-1003",
            "fax_number": "502-371-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANE RUN SMILE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "SUSIE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-448-1003",
        "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": "5214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID SUBCONTRACTOR #",
            "identifier": "168937",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61942785",
            "state": "KY"
        }
    ],
    "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 Feb 9, 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.