Provider Demographics
NPI:1568829257
Name:LORD FAMILY DENTAL
Entity Type:Organization
Organization Name:LORD FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-267-4141
Mailing Address - Street 1:3841 RUCKRIEGEL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3986
Mailing Address - Country:US
Mailing Address - Phone:502-267-4141
Mailing Address - Fax:502-267-5952
Practice Address - Street 1:3841 RUCKRIEGEL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3986
Practice Address - Country:US
Practice Address - Phone:502-267-4141
Practice Address - Fax:502-267-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty