Provider Demographics
NPI:1508034679
Name:DOMENIC M. CALUORI DMD PLLC
Entity Type:Organization
Organization Name:DOMENIC M. CALUORI DMD PLLC
Other - Org Name:CLINIC32
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALUORI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-244-4474
Mailing Address - Street 1:13100 MAGISTERIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4102
Mailing Address - Country:US
Mailing Address - Phone:502-244-4474
Mailing Address - Fax:309-406-4143
Practice Address - Street 1:13100 MAGISTERIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4102
Practice Address - Country:US
Practice Address - Phone:502-244-4474
Practice Address - Fax:309-406-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty