Provider Demographics
NPI:1669937058
Name:HOMETOWN FAMILY DENTAL
Entity type:Organization
Organization Name:HOMETOWN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VENOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-896-1032
Mailing Address - Street 1:4122 SHELBYVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3212
Mailing Address - Country:US
Mailing Address - Phone:502-896-1032
Mailing Address - Fax:
Practice Address - Street 1:4122 SHELBYVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3212
Practice Address - Country:US
Practice Address - Phone:502-896-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental