Provider Demographics
NPI:1295007383
Name:SPECIAL CARE DENTAL OF KENTUCKY PLLC
Entity Type:Organization
Organization Name:SPECIAL CARE DENTAL OF KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-214-0693
Mailing Address - Street 1:PO BOX 436149
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-6149
Mailing Address - Country:US
Mailing Address - Phone:502-214-0693
Mailing Address - Fax:502-254-4077
Practice Address - Street 1:12910 SHELBYVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2404
Practice Address - Country:US
Practice Address - Phone:502-214-0693
Practice Address - Fax:502-254-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty