Provider Demographics
NPI:1962545277
Name:O'BANION, L. DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:L.
Middle Name:DAVID
Last Name:O'BANION
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N EVERGREEN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1410
Mailing Address - Country:US
Mailing Address - Phone:052-245-3707
Mailing Address - Fax:502-245-2671
Practice Address - Street 1:138 N EVERGREEN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1410
Practice Address - Country:US
Practice Address - Phone:052-245-3707
Practice Address - Fax:502-245-2671
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58691223G0001X
INDN 109561223G0001X
FL12010515A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice