Provider Demographics
NPI:1760749493
Name:FLORENCE FAMILY DENTAL, INC
Entity Type:Organization
Organization Name:FLORENCE FAMILY DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-235-4804
Mailing Address - Street 1:2426 TYLER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2637
Mailing Address - Country:US
Mailing Address - Phone:502-235-4804
Mailing Address - Fax:
Practice Address - Street 1:6616 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2171
Practice Address - Country:US
Practice Address - Phone:859-371-3950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty