| Dhda Providerco, Pllc | |
|
13104 W Highway 42 Prospect KY 40059-9102 | |
| (502) 228-0234 | |
| Not Available |
| Full Name | Dhda Providerco, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 13104 W Highway 42, Prospect, Kentucky |
| Authorized Official Name and Position | Paul T Lavelle (SOLE MEMBER) |
| Authorized Official Contact | 5022280404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dhda Providerco, Pllc 13104 W Highway 42 Prospect KY 40059-9102 Ph: () - | Dhda Providerco, Pllc 13104 W Highway 42 Prospect KY 40059-9102 Ph: (502) 228-0234 |
| NPI Number | 1902432537 |
|---|---|
| Provider Enumeration Date | 03/16/2020 |
| Last Update Date | 03/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902432537 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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