| Cane Run Smile Center, Inc. | |
|
3050 W Broadway Louisville KY 40211-1475 | |
| (502) 778-2631 | |
| (502) 776-3454 |
| Full Name | Cane Run Smile Center, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3050 W Broadway, Louisville, Kentucky |
| Authorized Official Name and Position | Susie J. Riley (OWNER) |
| Authorized Official Contact | 5027782631 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cane Run Smile Center, Inc. 3050 W Broadway Louisville KY 40211-1475 Ph: (502) 778-2631 | Cane Run Smile Center, Inc. 3050 W Broadway Louisville KY 40211-1475 Ph: (502) 778-2631 |
| NPI Number | 1649325457 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649325457 | NPI | - | NPPES |
| 61942785 | Medicaid | KY | |
| 168938 | Other | KY | MEDICAID SUBCONTRACTOR # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5214 (Kentucky) | Primary |
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