Provider Demographics
NPI:1699296335
Name:FOUNDATIONS FAMILY AND IMPLANT DENTISTRY
Entity type:Organization
Organization Name:FOUNDATIONS FAMILY AND IMPLANT DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENDER
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:PARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-895-8261
Mailing Address - Street 1:3618 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2950
Mailing Address - Country:US
Mailing Address - Phone:502-895-8261
Mailing Address - Fax:502-893-9616
Practice Address - Street 1:11416 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1306
Practice Address - Country:US
Practice Address - Phone:502-245-8442
Practice Address - Fax:502-245-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental