Provider Demographics
NPI:1356452874
Name:ESPOSITO, CARMINE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:J
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY
Mailing Address - Street 2:501 S. PRESTON ST.
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40292-0001
Mailing Address - Country:US
Mailing Address - Phone:502-852-5128
Mailing Address - Fax:502-852-7163
Practice Address - Street 1:UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY
Practice Address - Street 2:501 S. PRESTON ST.
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-5128
Practice Address - Fax:502-852-7163
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60047057Medicaid
KY9179034Medicaid
KY62660OtherANTHEM
KY0053004Medicare ID - Type Unspecified