Provider Demographics
NPI:1245229079
Name:PIERCE & MITCHELL, P.S.C.
Entity Type:Organization
Organization Name:PIERCE & MITCHELL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:DEANE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-366-6362
Mailing Address - Street 1:4825 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2152
Mailing Address - Country:US
Mailing Address - Phone:502-366-6362
Mailing Address - Fax:502-368-8600
Practice Address - Street 1:4825 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2152
Practice Address - Country:US
Practice Address - Phone:502-366-6362
Practice Address - Fax:502-368-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900379Medicaid