Provider Demographics
NPI:1912559345
Name:CARDWELL, CHRISTINA DAWN (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAWN
Last Name:CARDWELL
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 1:401 MACON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3764
Mailing Address - Country:US
Mailing Address - Phone:270-999-1183
Mailing Address - Fax:
Practice Address - Street 1:1250 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7178
Practice Address - Country:US
Practice Address - Phone:502-922-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice