Provider Demographics
NPI:1033860341
Name:PADDOCK DENTAL
Entity Type:Organization
Organization Name:PADDOCK DENTAL
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 1:3002 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3020
Mailing Address - Country:US
Mailing Address - Phone:502-451-2212
Mailing Address - Fax:502-456-0849
Practice Address - Street 1:3002 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3020
Practice Address - Country:US
Practice Address - Phone:502-451-2212
Practice Address - Fax:502-456-0849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PADDOCK DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty