Provider Demographics
NPI:1730831009
Name:CALISU 3, PLLC
Entity type:Organization
Organization Name:CALISU 3, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAIACONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-451-2212
Mailing Address - Street 1:5912 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1957
Mailing Address - Country:US
Mailing Address - Phone:502-239-0881
Mailing Address - Fax:502-239-0887
Practice Address - Street 1:5912 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1957
Practice Address - Country:US
Practice Address - Phone:502-239-0881
Practice Address - Fax:502-239-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty