Provider Demographics
NPI:1326137217
Name:EAST LOUISVILLE DENTAL GROUP
Entity Type:Organization
Organization Name:EAST LOUISVILLE DENTAL GROUP
Other - Org Name:F. RICHARD SCHMITT DMD PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:F.
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-245-5418
Mailing Address - Street 1:PO BOX 43300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-0300
Mailing Address - Country:US
Mailing Address - Phone:502-245-5418
Mailing Address - Fax:502-245-5429
Practice Address - Street 1:205 MOSER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3113
Practice Address - Country:US
Practice Address - Phone:502-245-5418
Practice Address - Fax:502-245-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty