Provider Demographics
NPI:1598937344
Name:EMBRY & O'CONNOR, INC
Entity Type:Organization
Organization Name:EMBRY & O'CONNOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-495-2444
Mailing Address - Street 1:3044 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2192
Mailing Address - Country:US
Mailing Address - Phone:502-495-2444
Mailing Address - Fax:502-495-2579
Practice Address - Street 1:3044 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2192
Practice Address - Country:US
Practice Address - Phone:502-495-2444
Practice Address - Fax:502-495-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty