1112 Poplar Level Plz Apt 26, Louisville, KY 40217
Phone
(423) 863-1701
Listed under
Periodontists
NPI
1013548551
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Periodontics (1223P0300X)
License number on NPI record
00205572 (CO)
NPI first issued
Feb 3, 2020
NPI record last updated
Jan 13, 2026
NPI 1013548551 is active in the federal NPPES registry (CMS) with Periodontics, an ADA-recognized dental specialty, as its primary taxonomy; license 00205572 (CO) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Periodontists specialize in the gums and bone that support the teeth, including placing implants, gum and bone grafting, and treating gum disease. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.