Provider Demographics
NPI:1710725809
Name:DISTLER FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:DISTLER FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-523-2433
Mailing Address - Street 1:2221 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1330
Mailing Address - Country:US
Mailing Address - Phone:502-458-7744
Mailing Address - Fax:502-458-7707
Practice Address - Street 1:2221 MEADOW DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1330
Practice Address - Country:US
Practice Address - Phone:502-458-7744
Practice Address - Fax:502-458-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center