Provider Demographics
NPI:1215947916
Name:ALBERS, JACQUELINE M (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:M
Last Name:ALBERS
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 1:2323 LIME KILN LN. SUITE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-423-0781
Mailing Address - Fax:502-423-8940
Practice Address - Street 1:2323 LIME KILN LN. SUITE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-423-0781
Practice Address - Fax:502-423-8940
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice