Provider Demographics
NPI:1851125736
Name:DENTIST IN LOUISVILLE LLC
Entity type:Organization
Organization Name:DENTIST IN LOUISVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-830-6881
Mailing Address - Street 1:1305 KNOX ABBOTT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3348
Mailing Address - Country:US
Mailing Address - Phone:803-830-6881
Mailing Address - Fax:
Practice Address - Street 1:6826 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3050
Practice Address - Country:US
Practice Address - Phone:803-830-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty