NPIMap

Organization Active NPI

Lifetime Dental Care of Ky PSC

Doing business as St. Mathews Dental Care

  • Dentist
  • Louisville, KY
National Provider Identifier
1942364930
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LIFETIME DENTAL CARE OF KY PSC
Doing business as
St. Mathews Dental Care
Practice address
100 Marshall Dr
Louisville, KY 40207-3459
Phone
(502) 897-3424
Fax
(502) 894-0342
NPI assigned
Dec 21, 2006
Last updated
Dec 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFETIME DENTAL CARE OF KY PSCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

100 Marshall Dr
Louisville, KY 40207-3459

Mailing address

100 Marshall Dr
Louisville, KY 40207-3459
Phone (502) 897-3424

Other names 1

  • St. Mathews Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Dental Care of Ky PSC4 organizations share this tax ID, including this one
Part of
Lifetime Dental Care of Ky PSC

Other organizations with this tax ID 3

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

Locations

100 Marshall Dr
Louisville, KY 40207
Phone (502) 897-3424

219 Breckenridge Ln
Louisville, KY 40207
Phone (502) 897-3424

Practitioners & affiliated clinicians

Practitioners 1

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1942364930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MARSHALL DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402073459",
            "telephone_number": "502-897-3424",
            "fax_number": "502-894-0342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARSHALL DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402073459",
            "telephone_number": "502-897-3424",
            "fax_number": "502-894-0342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL CARE OF KY PSC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFETIME DENTAL CARE OF KY PSC",
        "enumeration_date": "2006-12-21",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mathews Dental Care",
            "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 Dec 20, 2024; 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.