East Louisville Oral Surgery and Dental Implants PLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC

Practice address

300 Middletown Park PL Ste a
Louisville, KY 40243-2541

Phone

(502) 254-3818

Fax

(502) 254-3819

NPI assigned

Nov 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Wayne Livesay Jr., D.M.D

Title

Oral Surgeon

Phone

(502) 254-3818

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Martin A Segal, DMD

  • General Practice Dentistry
  • Louisville, KY
  • NPI 1861534679
  NPD (past)

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576108800000",
    "number": "1972782407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 N DUPONT SQ STE B",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074612",
            "telephone_number": "502-897-5282",
            "fax_number": "502-896-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MIDDLETOWN PARK PL STE A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432541",
            "telephone_number": "502-254-3818",
            "fax_number": "502-254-3819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1013 N DuPont Sq Ste B",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402074612",
            "country_code": "US",
            "telephone_number": "502-897-5282",
            "fax_number": "502-896-6714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4181 New Shepherdsville Rd",
            "address_purpose": "LOCATION",
            "city": "Bardstown",
            "state": "KY",
            "postal_code": "400049021",
            "country_code": "US",
            "telephone_number": "502-305-3649",
            "fax_number": "502-373-6562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST LOUISVILLE ORAL SURGERY AND DENTAL IMPLANTS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A",
        "authorized_official_last_name": "LIVESAY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "502-254-3818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100122880",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Louisville Inpatient Medicine, PLLC
• East Louisville Interventional Pain Specialists PLLC
• East Louisville Interventional Pain Specialists, PLLC
• East Louisville Neurology, PSC
• East Louisville Oral Surgery and Dental Implants PLC
• East Louisville Pathologists PSC
• East Louisville Pediatrics, P.S.C.
• East Louisville Speech Therapy, LLC
• East Tennessee Wound Care PC
• Emily Beth East

• Oral and Maxillofacial Surgery (Dentist) in Louisville, KY
• Providers in Louisville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; 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.