Provider Demographics
NPI:1306835632
Name:FRED LOOK, P.S.C., D.M.D.
Entity Type:Organization
Organization Name:FRED LOOK, P.S.C., D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-448-7988
Mailing Address - Street 1:5141 DIXIE HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1765
Mailing Address - Country:US
Mailing Address - Phone:502-448-7988
Mailing Address - Fax:502-447-9326
Practice Address - Street 1:5141 DIXIE HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1765
Practice Address - Country:US
Practice Address - Phone:502-448-7988
Practice Address - Fax:502-447-9326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1118401Medicare ID - Type Unspecified
KYU02714Medicare UPIN