Provider Demographics
NPI:1184837981
Name:EAST END FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:EAST END FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIGMUND
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-454-3758
Mailing Address - Street 1:3022 TAYLORSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-454-3758
Mailing Address - Fax:502-454-4860
Practice Address - Street 1:3022 TAYLORSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-454-3758
Practice Address - Fax:502-454-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty