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MODERN KIDS DENTISTRY OF LOUISVILLE, PLLC
NPI 1104646983
Dentist - Pediatric Dentistry in Louisville, KY

Active since October 15, 2024
129 EVERGREEN RD, LOUISVILLE, KY 40243(502) 245-8855 Get Directions Write a Review

NPPES record last updated: October 15, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Modern Kids Dentistry Of Louisville, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MODERN KIDS DENTISTRY OF LOUISVILLE, PLLC (NPI 1104646983) is a healthcare organization registered as a pediatric dentistry in Louisville, Kentucky and active in the NPI registry since October 2024. The organization lists Justin M Raybould, Owner, as its authorized official.

NPPES Registry Identity

NPI1104646983
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameMODERN KIDS DENTISTRY OF LOUISVILLE, PLLC
Location Address129 EVERGREEN RDLouisville, KY 40243-2426
Mailing Address129 Evergreen RdLouisville, KY 40243-2426 · (502) 245-8855
Phone(502) 245-8855
Organization SubpartNo
Authorized OfficialJustin M RaybouldOwner · (859) 321-7051
Enumeration DateOctober 15, 2024
NPPES CertifiedOctober 15, 2024
✔ NPI 1104646983 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
129 EVERGREEN RD, Louisville, KY 40243
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Modern Kids Dentistry Of Louisville, PLLC's NPI number?

The NPI number for Modern Kids Dentistry Of Louisville, PLLC is 1104646983. It was assigned to this organization in the NPPES registry on October 15, 2024.

Where is Modern Kids Dentistry Of Louisville, PLLC located?

Modern Kids Dentistry Of Louisville, PLLC is located at 129 Evergreen Rd, Louisville, KY 40243. The listed phone number is (502) 245-8855.

What is Modern Kids Dentistry Of Louisville, PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Modern Kids Dentistry Of Louisville, PLLC was last updated on October 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.