Provider Demographics
NPI:1417413824
Name:AFFORDABLE DENTURES & IMPLANTS - KENTUCKY, PLLC
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - KENTUCKY, PLLC
Other - Org Name:AFFORDABLE DENTURES & IMPLANTS - LOUISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-733-8551
Mailing Address - Street 1:2010 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4207
Mailing Address - Country:US
Mailing Address - Phone:502-491-0054
Mailing Address - Fax:
Practice Address - Street 1:2010 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4207
Practice Address - Country:US
Practice Address - Phone:502-491-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty