Provider Demographics
NPI:1609570662
Name:DENTURE CITY PLUS LLC
Entity Type:Organization
Organization Name:DENTURE CITY PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PETREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-224-3274
Mailing Address - Street 1:3023 CRUMS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4471
Mailing Address - Country:US
Mailing Address - Phone:502-447-3962
Mailing Address - Fax:502-449-3737
Practice Address - Street 1:3023 CRUMS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4471
Practice Address - Country:US
Practice Address - Phone:502-447-3962
Practice Address - Fax:502-449-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental