Provider Demographics
NPI:1790848026
Name:LIFETIME DENTAL CARE OF KENTUCKY, P.S.C. - DR WAYNE OLGES
Entity Type:Organization
Organization Name:LIFETIME DENTAL CARE OF KENTUCKY, P.S.C. - DR WAYNE OLGES
Other - Org Name:FOREST GREEN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:10031 FOREST GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5119
Mailing Address - Country:US
Mailing Address - Phone:502-412-7587
Mailing Address - Fax:502-412-7066
Practice Address - Street 1:10031 FOREST GREEN BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5119
Practice Address - Country:US
Practice Address - Phone:502-412-7587
Practice Address - Fax:502-412-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty