Provider Demographics
NPI:1720404478
Name:LOUISA DENTAL CARE
Entity Type:Organization
Organization Name:LOUISA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-638-4689
Mailing Address - Street 1:203 S. WATER ST P.O. BOX 70
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230
Mailing Address - Country:US
Mailing Address - Phone:606-638-4689
Mailing Address - Fax:606-483-8005
Practice Address - Street 1:203 S. WATER ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-4689
Practice Address - Fax:606-483-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6598122300000X
KY6690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty