Provider Demographics
NPI:1144838764
Name:MY SMILE DENTAL SERVICES, PLLC
Entity type:Organization
Organization Name:MY SMILE DENTAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ISING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-670-0403
Mailing Address - Street 1:5014B PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-2217
Mailing Address - Country:US
Mailing Address - Phone:502-966-0188
Mailing Address - Fax:502-966-0189
Practice Address - Street 1:5014B PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2217
Practice Address - Country:US
Practice Address - Phone:502-966-0188
Practice Address - Fax:502-966-0189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY SMILE DENTAL SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty