Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Specialized Dental Services-Jefferson Mall, PLLC

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1033397914

Specialized Dental Services-Jefferson Mall, PLLC is an Oral and Maxillofacial Surgery (Dentist) in Louisville, Kentucky. Registered with an NPI since 2008.

In the registry since
2008
Specialties on file
3
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5100 Outer Loop Ste B
Louisville, KY 40219-4056
Phone: (502) 410-1702
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X
Anesthesiology Physician Taxonomy 207L00000X

Record details

NPI number1033397914
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Reibel — Chief Financial Officer · (502) 254-8526
NPI enumeratedFebruary 4, 2008
Last updated in NPPESAugust 2, 2024
Certification dateAugust 2, 2024
Mailing addressPo Box 437169, Louisville, KY 40253-7169

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