Provider Demographics
NPI:1659369148
Name:LYVERS, JOSEPH DARRELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DARRELL
Last Name:LYVERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2780
Mailing Address - Country:US
Mailing Address - Phone:502-429-0665
Mailing Address - Fax:502-366-6821
Practice Address - Street 1:3448 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2648
Practice Address - Country:US
Practice Address - Phone:502-367-0571
Practice Address - Fax:502-366-6821
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60060456Medicaid
KYYB67OtherBC/BS