Provider Demographics
NPI:1033577606
Name:ANSLEY H DEPP PLLC
Entity Type:Organization
Organization Name:ANSLEY H DEPP PLLC
Other - Org Name:DENTAL BLU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEPP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-442-8200
Mailing Address - Street 1:2600 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1590
Mailing Address - Country:US
Mailing Address - Phone:859-442-8200
Mailing Address - Fax:859-442-9555
Practice Address - Street 1:2600 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1590
Practice Address - Country:US
Practice Address - Phone:859-442-8200
Practice Address - Fax:859-442-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7519370001OtherMEDICARE PTAN
KY7519370001Medicare NSC