| Immediadent | |
|
2011 Grinstead Dr Unit 102 Louisville KY 40204-1296 | |
| (502) 638-2377 | |
| (913) 752-9116 |
| Full Name | Immediadent |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2011 Grinstead Dr Unit 102, Louisville, Kentucky |
| Authorized Official Name and Position | Monica L Long (MANAGER OF CREDENTIALING) |
| Authorized Official Contact | 9134281686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immediadent Po Box 11568 Overland Park KS 66207-4268 Ph: (913) 428-1686 | Immediadent 2011 Grinstead Dr Unit 102 Louisville KY 40204-1296 Ph: (502) 638-2377 |
| NPI Number | 1194238816 |
|---|---|
| Provider Enumeration Date | 11/16/2017 |
| Last Update Date | 11/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194238816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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