Provider Demographics
NPI:1720290026
Name:METRO LOUISVILLE ENDODONTICS,LLC
Entity Type:Organization
Organization Name:METRO LOUISVILLE ENDODONTICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-495-1822
Mailing Address - Street 1:3036 BRECKENRIDGE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2196
Mailing Address - Country:US
Mailing Address - Phone:502-495-1822
Mailing Address - Fax:502-495-1825
Practice Address - Street 1:3036 BRECKENRIDGE LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2196
Practice Address - Country:US
Practice Address - Phone:502-495-1822
Practice Address - Fax:502-495-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6102OtherDENTAL LICENSE NUMBER