NPIMap

Organization Active NPI

Pediatric Dental Group of Louisville

  • Pediatric Dentistry
  • Louisville, KY
National Provider Identifier
1942329495
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
PEDIATRIC DENTAL GROUP OF LOUISVILLE
Practice address
9710 Park Plaza Ave
Suite 101
Louisville, KY 40241-2291
Phone
(502) 327-6380
Fax
(502) 327-8650
NPI assigned
Mar 28, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Connie Ison
Title
Business Manager
Phone
(502) 327-6380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

9710 Park Plaza Ave
Suite 101
Louisville, KY 40241-2291

Mailing address

9710 Park Plaza Ave
Suite 101
Louisville, KY 40241-2291
Phone (502) 327-6380

National Provider Directory

National Provider Directory

Locations

9710 Park Plaza Ave
Unit 101
Louisville, KY 40241
Phone (502) 327-6380

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942329495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9710 PARK PLAZA AVE",
            "address_2": "SUITE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412291",
            "telephone_number": "502-327-6380",
            "fax_number": "502-327-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9710 PARK PLAZA AVE",
            "address_2": "SUITE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412291",
            "telephone_number": "502-327-6380",
            "fax_number": "502-327-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL GROUP OF LOUISVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ISON",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "502-327-6380",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "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 22, 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.