Provider Demographics
NPI:1275046542
Name:DPP PLLC
Entity Type:Organization
Organization Name:DPP PLLC
Other - Org Name:FAMILY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-295-2329
Mailing Address - Street 1:8000 WILLIAM G PENNY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3739
Mailing Address - Country:US
Mailing Address - Phone:502-969-2396
Mailing Address - Fax:
Practice Address - Street 1:8000 WILLIAM G PENNY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3739
Practice Address - Country:US
Practice Address - Phone:502-969-2396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7615261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTIN