Provider Demographics
NPI:1679564454
Name:MUDD, ANN BETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:BETH
Last Name:MUDD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2561
Mailing Address - Country:US
Mailing Address - Phone:502-897-6453
Mailing Address - Fax:502-897-6453
Practice Address - Street 1:3516 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2561
Practice Address - Country:US
Practice Address - Phone:502-897-6453
Practice Address - Fax:502-897-6453
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist