Provider Demographics
NPI:1871320663
Name:OAK TREE DENTAL PLLC
Entity type:Organization
Organization Name:OAK TREE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-386-7147
Mailing Address - Street 1:2323 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3416
Mailing Address - Country:US
Mailing Address - Phone:502-423-0781
Mailing Address - Fax:
Practice Address - Street 1:2323 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3416
Practice Address - Country:US
Practice Address - Phone:502-423-0781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental